Provider Demographics
NPI:1598758674
Name:LMR IMAGING
Entity Type:Organization
Organization Name:LMR IMAGING
Other - Org Name:LMR IMAGING CAPE CORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-983-9950
Mailing Address - Street 1:1455 BROAD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3003
Mailing Address - Country:US
Mailing Address - Phone:973-707-1100
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:636 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2668
Practice Address - Country:US
Practice Address - Phone:239-574-3339
Practice Address - Fax:239-574-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5725Medicare ID - Type Unspecified