Organization Name: | FLAGLER DIAGNOSTIC IMAGING, LLC |
NPI Number: | 1033171186 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KERRY A TRETHEWAY (CHIEF OPERATING OFFICER) |
Mailing Address: | 10 B Florida Park Drive Palm Coast |
State: | FL US |
Postal Code: | 32135 |
Phone Number: | 3864453355 |
Fax Number: | 3864458999 |
NPI Enumeration Date: | 04/04/2006 |
NPI Last Update Date: | 06/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |