Provider Demographics
NPI:1659347037
Name:VIERA DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:VIERA DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:ABAYOMI
Authorized Official - Last Name:OLOMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-254-7880
Mailing Address - Street 1:7000 SPYGLASS CT
Mailing Address - Street 2:SUITE 260
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8288
Mailing Address - Country:US
Mailing Address - Phone:321-254-7880
Mailing Address - Fax:321-254-7707
Practice Address - Street 1:7000 SPYGLASS CT
Practice Address - Street 2:SUITE 260
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8288
Practice Address - Country:US
Practice Address - Phone:321-254-7880
Practice Address - Fax:321-254-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5570261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4543Medicare PIN
FLDA1535Medicare PIN