Provider Demographics
NPI:1346698669
Name:IRVING RADIOLOGY, INC
Entity Type:Organization
Organization Name:IRVING RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:DACOSTA
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:646-725-2800
Mailing Address - Street 1:4110 CENTER POINTE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9424
Mailing Address - Country:US
Mailing Address - Phone:646-725-2800
Mailing Address - Fax:866-908-1231
Practice Address - Street 1:4110 CENTER POINTE DR STE 210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916
Practice Address - Country:US
Practice Address - Phone:646-725-2800
Practice Address - Fax:866-908-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1162592085R0202X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty