Provider Demographics
NPI:1952772089
Name:PUTNAM IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:PUTNAM IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERINCHERY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-338-2089
Mailing Address - Street 1:3426 NW 43RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8156
Mailing Address - Country:US
Mailing Address - Phone:352-338-2089
Mailing Address - Fax:386-530-2067
Practice Address - Street 1:6300 ST. JOHNS AVE.
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3884
Practice Address - Country:US
Practice Address - Phone:386-202-4006
Practice Address - Fax:386-385-5699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUTNAM PHYSICIANS GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-15
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54477207P00000X
FLME64833207R00000X
FLME81873207RG0100X
FLME54534207RP1001X
FLME76357208800000X
FLPO2829213ES0103X
FLPO2712213ES0103X
FLPO2627213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty