Provider Demographics
NPI:1376819888
Name:ELITE IMAGING LLC
Entity Type:Organization
Organization Name:ELITE IMAGING LLC
Other - Org Name:AKUMIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-515-0362
Mailing Address - Street 1:8300 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5406
Mailing Address - Country:US
Mailing Address - Phone:954-577-6000
Mailing Address - Fax:954-577-5816
Practice Address - Street 1:8300 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5406
Practice Address - Country:US
Practice Address - Phone:954-577-6000
Practice Address - Fax:954-577-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3535AMedicare PIN