Provider Demographics
NPI:1619967965
Name:LAD IMAGING, LLC
Entity Type:Organization
Organization Name:LAD IMAGING, LLC
Other - Org Name:NO DBA LAD IMAGING , LLC (ORANGE CITY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:942 SAXON BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8313
Mailing Address - Country:US
Mailing Address - Phone:386-774-5752
Mailing Address - Fax:386-774-6784
Practice Address - Street 1:942 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8313
Practice Address - Country:US
Practice Address - Phone:386-774-5752
Practice Address - Fax:386-774-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty