Provider Demographics
NPI:1518911668
Name:FLORIDA RADIOLOGY CONSULTANTS P A
Entity Type:Organization
Organization Name:FLORIDA RADIOLOGY CONSULTANTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-331-5566
Mailing Address - Street 1:8791 CONFERENCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-331-5566
Mailing Address - Fax:239-437-7499
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5864
Practice Address - Country:US
Practice Address - Phone:239-331-5566
Practice Address - Fax:239-377-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNA2085N0904X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262870800Medicaid
FL262870815Medicaid
FL262870807Medicaid
FL262870808Medicaid
FL262870814Medicaid
FL262870816Medicaid
FLCJ5512OtherRR MEDICARE
FL262870811Medicaid
FL262870805Medicaid
FL262870806Medicaid
FL262870809Medicaid
FL262870810Medicaid
FL262870813Medicaid
FL262870804Medicaid
FL38168OtherBCBS OF FLORIDA
FL262870812Medicaid
FL262870812Medicaid