Provider Demographics
NPI:1013087865
Name:ALTEC DIAGNOSTICS & IMAGING INC
Entity type:Organization
Organization Name:ALTEC DIAGNOSTICS & IMAGING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-675-2439
Mailing Address - Street 1:5562 SPRING PARK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5549
Mailing Address - Country:US
Mailing Address - Phone:904-854-6741
Mailing Address - Fax:631-517-8007
Practice Address - Street 1:5562 SPRING PARK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5549
Practice Address - Country:US
Practice Address - Phone:904-854-6741
Practice Address - Fax:904-425-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4974Medicare ID - Type Unspecified