Provider Demographics
NPI:1659821585
Name:RISGIMM, LLC
Entity Type:Organization
Organization Name:RISGIMM, LLC
Other - Org Name:PLANT CITY MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GOODEMOTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN
Authorized Official - Phone:863-577-0303
Mailing Address - Street 1:2125 CRYSTAL GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6875
Mailing Address - Country:US
Mailing Address - Phone:863-577-0303
Mailing Address - Fax:863-577-0301
Practice Address - Street 1:206 W ALEXANDER ST STE 1
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7100
Practice Address - Country:US
Practice Address - Phone:863-577-0303
Practice Address - Fax:863-577-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty