Provider Demographics
NPI:1952479453
Name:INNOVATIVE MEDICAL IMAGING-NAPLES LLC
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL IMAGING-NAPLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING
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:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5653261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3153Medicare ID - Type Unspecified