Provider Demographics
NPI:1255374286
Name:CENTRAL FLORIDA RADIOLOGY LLC
Entity type:Organization
Organization Name:CENTRAL FLORIDA RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-971-0123
Mailing Address - Street 1:942 SAXON BLVD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8358
Mailing Address - Country:US
Mailing Address - Phone:386-456-5293
Mailing Address - Fax:386-456-5142
Practice Address - Street 1:942 SAXON BLVD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8358
Practice Address - Country:US
Practice Address - Phone:386-456-5293
Practice Address - Fax:386-456-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF5858Medicare PIN
FLK9594Medicare PIN