Provider Demographics
NPI:1598243867
Name:MDIG OF FLORIDA, LLC
Entity Type:Organization
Organization Name:MDIG OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:809-991-0914
Mailing Address - Street 1:10835 N 25TH AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3458
Mailing Address - Country:US
Mailing Address - Phone:480-999-1091
Mailing Address - Fax:602-812-4985
Practice Address - Street 1:10835 N 25TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3408
Practice Address - Country:US
Practice Address - Phone:480-999-1091
Practice Address - Fax:602-812-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty