Provider Demographics
NPI:1356530091
Name:RADIOLOGY CONSULTANTS PA
Entity type:Organization
Organization Name:RADIOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-293-1071
Mailing Address - Street 1:PO BOX 2317
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33883-2317
Mailing Address - Country:US
Mailing Address - Phone:863-293-1071
Mailing Address - Fax:
Practice Address - Street 1:130 BATES AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2953
Practice Address - Country:US
Practice Address - Phone:863-293-1071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN1297OtherRR MEDICARE
FL00297Medicare PIN