Provider Demographics
NPI:1922172865
Name:IMED DIAGNOSTIC SERVICES OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:IMED DIAGNOSTIC SERVICES OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STERNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-597-5530
Mailing Address - Street 1:5650 STRAND CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-3343
Mailing Address - Country:US
Mailing Address - Phone:239-597-5530
Mailing Address - Fax:239-597-7825
Practice Address - Street 1:5650 STRAND CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-3343
Practice Address - Country:US
Practice Address - Phone:239-597-5530
Practice Address - Fax:239-597-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7586261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2925OtherBLUECROSS PROVIDER
FLV2925OtherBLUECROSS PROVIDER