Provider Demographics
NPI:1457540064
Name:DIAGNOSTIC IMAGING SERVICES INC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-220-1391
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0004
Mailing Address - Country:US
Mailing Address - Phone:772-220-1391
Mailing Address - Fax:772-220-4087
Practice Address - Street 1:1796 HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1918
Practice Address - Country:US
Practice Address - Phone:772-220-1391
Practice Address - Fax:772-220-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063061601Medicaid
FL063061601Medicaid