Provider Demographics
NPI:1972666113
Name:IMAGING CENTER AT LAKEWOOD LLC
Entity Type:Organization
Organization Name:IMAGING CENTER AT LAKEWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-391-1600
Mailing Address - Street 1:2301 UNIVERSITY BLVD WEST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2022
Mailing Address - Country:US
Mailing Address - Phone:904-448-2299
Mailing Address - Fax:904-448-2298
Practice Address - Street 1:2345 FORBES ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4311
Practice Address - Country:US
Practice Address - Phone:904-391-1600
Practice Address - Fax:904-391-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME595542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD76199Medicare UPIN
FL12417Medicare ID - Type Unspecified