Provider Demographics
NPI:1710948708
Name:NEW SMYRNA IMAGING, LLC
Entity Type:Organization
Organization Name:NEW SMYRNA IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LW
Authorized Official - Last Name:POSTELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS, CHBME
Authorized Official - Phone:386-426-1900
Mailing Address - Street 1:405 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-3129
Mailing Address - Country:US
Mailing Address - Phone:386-426-1900
Mailing Address - Fax:386-426-5939
Practice Address - Street 1:405 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3129
Practice Address - Country:US
Practice Address - Phone:386-426-1900
Practice Address - Fax:386-426-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E9136Medicare ID - Type Unspecified