Provider Demographics
NPI:1477830818
Name:SIMONMED IMAGING FLORIDA LLC
Entity Type:Organization
Organization Name:SIMONMED IMAGING FLORIDA LLC
Other - Org Name:SIMONMED IMAGING TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-809-6623
Mailing Address - Street 1:6900 E CAMELBACK RD STE 700
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2400
Mailing Address - Country:US
Mailing Address - Phone:480-306-6949
Mailing Address - Fax:602-302-5706
Practice Address - Street 1:14302 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2601
Practice Address - Country:US
Practice Address - Phone:813-979-7580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
261QR0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile MammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004602901Medicaid
FLFW240OtherSIMONMED IMAGING OCOEE II
FLFW240AOtherSIMONMED IMAGING SUN CITY
FL004602906Medicaid
FL004602909Medicaid
FL004602910Medicaid
FLFW240OtherSIMONMED IMAGING POINCIANA
FLFW240OtherSIMONMED IMAGING LAKE MARY II
FLFW240OtherSIMONMED IMAGING LONGWOOD
FLFW240OtherSIMONMED IMAGING CLERMONT
FL004602902Medicaid
FL004602905Medicaid
FL004602907Medicaid
FL004602908Medicaid
FLDS5839OtherRAILROAD MEDICARE
FLFW240OtherSIMONMED IMAGING TAMPA
FL004602903Medicaid
FL004602904Medicaid