Provider Demographics
NPI:1952396194
Name:WOMEN CENTER FOR RADIOLOGY
Entity Type:Organization
Organization Name:WOMEN CENTER FOR RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BELMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-581-4140
Mailing Address - Street 1:1621 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1849
Mailing Address - Country:US
Mailing Address - Phone:407-841-0822
Mailing Address - Fax:
Practice Address - Street 1:1621 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1849
Practice Address - Country:US
Practice Address - Phone:407-841-0822
Practice Address - Fax:407-581-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME268722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCV2475OtherBCBS
FLCI5806OtherMEDICARE RAILROAD
FLV2476OtherBCBS/OUR OTHER OFFICE ORG
FL085100OtherAVMED
FL373501000Medicaid
FL085100OtherAVMED