Provider Demographics
NPI:1750315081
Name:RADIOLOGY ASSOCIATES OF LAKE CITY PA
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF LAKE CITY PA
Other - Org Name:RICARDO BEDOYA, M.D.-SERGIO LAGMAN,M.D.,P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDOYA-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-752-9144
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-0691
Mailing Address - Country:US
Mailing Address - Phone:386-752-9144
Mailing Address - Fax:386-752-5881
Practice Address - Street 1:183 NW GWEN LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3711
Practice Address - Country:US
Practice Address - Phone:386-752-9144
Practice Address - Fax:386-752-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00706Medicare ID - Type Unspecified