Provider Demographics
NPI:1396841805
Name:MID-FLORIDA IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:MID-FLORIDA IMAGING SERVICES LLC
Other - Org Name:WESTON DIAGNOSTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS,RVT,RDCS
Authorized Official - Phone:407-788-0455
Mailing Address - Street 1:24103 HARBECK LANE
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-8112
Mailing Address - Country:US
Mailing Address - Phone:407-788-0455
Mailing Address - Fax:407-389-0931
Practice Address - Street 1:24103 HARBECK LANE
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-8112
Practice Address - Country:US
Practice Address - Phone:407-788-0455
Practice Address - Fax:407-389-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL54687261QR0200X, 261QR0208X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory