Provider Demographics
NPI:1376515189
Name:FLORIDA RADIOLOGY MANAGEMENT LLC
Entity Type:Organization
Organization Name:FLORIDA RADIOLOGY MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-767-0433
Mailing Address - Street 1:PO BOX 150340
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32715-0340
Mailing Address - Country:US
Mailing Address - Phone:407-767-0433
Mailing Address - Fax:407-767-0608
Practice Address - Street 1:7050 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:813-783-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD609OtherRR MEDICARE - GROUP
FL94835OtherBCBS GROUP PROVIDER #
FLK7565Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER