Provider Demographics
NPI:1669744801
Name:RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Entity type:Organization
Organization Name:RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-688-2334
Mailing Address - Street 1:2115 CRYSTAL GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6875
Mailing Address - Country:US
Mailing Address - Phone:863-688-2334
Mailing Address - Fax:863-577-1160
Practice Address - Street 1:206 W ALEXANDER ST
Practice Address - Street 2:STE 1
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7100
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:863-577-1160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-03
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2720OtherBCBS FL