Provider Demographics
NPI:1427207240
Name:SOCA IMAGING INC
Entity Type:Organization
Organization Name:SOCA IMAGING INC
Other - Org Name:KISSIMMEE OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-665-1197
Mailing Address - Street 1:8100 ROYAL PALM BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5733
Mailing Address - Country:US
Mailing Address - Phone:954-341-2325
Mailing Address - Fax:954-341-6926
Practice Address - Street 1:1503 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4065
Practice Address - Country:US
Practice Address - Phone:407-847-8864
Practice Address - Fax:407-847-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty