Provider Demographics
NPI:1013908912
Name:INDEPENDENT IMAGING, LLC
Entity type:Organization
Organization Name:INDEPENDENT IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-909-0270
Mailing Address - Street 1:2425 E COMMERCIAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4003
Mailing Address - Country:US
Mailing Address - Phone:954-909-0270
Mailing Address - Fax:844-889-8133
Practice Address - Street 1:2425 E COMMERCIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4003
Practice Address - Country:US
Practice Address - Phone:954-909-0270
Practice Address - Fax:844-889-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC1449261QR0206X
FLHCC8429261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003527600Medicaid
FLV000BOtherBCBS
FL003527600Medicaid