Provider Demographics
NPI:1295038115
Name:LAKE CITY IMAGING LLC
Entity Type:Organization
Organization Name:LAKE CITY IMAGING LLC
Other - Org Name:INVISION IMAGING CENTER AT LAKE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5441
Mailing Address - Street 1:3140 NW MEDICAL CENTER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4717
Mailing Address - Country:US
Mailing Address - Phone:386-755-2020
Mailing Address - Fax:386-755-0690
Practice Address - Street 1:3140 NW MEDICAL CENTER LN
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4717
Practice Address - Country:US
Practice Address - Phone:386-755-2020
Practice Address - Fax:386-755-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLER360AMedicare PIN