Provider Demographics
NPI:1306848825
Name:MILLENNIUM IMAGING, INC.
Entity Type:Organization
Organization Name:MILLENNIUM IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:LADIKA JR
Authorized Official - Suffix:
Authorized Official - Credentials:RT, CVT
Authorized Official - Phone:941-755-5257
Mailing Address - Street 1:PO BOX 11440
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34282-1440
Mailing Address - Country:US
Mailing Address - Phone:941-755-5257
Mailing Address - Fax:941-755-4856
Practice Address - Street 1:10910 E STATE ROAD 70
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-8406
Practice Address - Country:US
Practice Address - Phone:941-755-5257
Practice Address - Fax:941-755-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5297261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6681Medicare ID - Type Unspecified