Provider Demographics
NPI:1013280361
Name:RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND PA
Entity Type:Organization
Organization Name:RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND PA
Other - Org Name:UPRIGHT OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-688-2334
Mailing Address - Street 1:PO BOX 20027
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0027
Mailing Address - Country:US
Mailing Address - Phone:866-804-7649
Mailing Address - Fax:614-210-1886
Practice Address - Street 1:1121 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4655
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:863-577-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3035OtherBCBS FL