| Organization Name: | LAKE WALES MEDICAL IMAGING CENTER ONE, INC |
| NPI Number: | 1063657955 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KOLLAGUNTA CHANDRASEKHAR (PRESIDENT) |
| Mailing Address: | 1255 Highway 60 East 110 Lake Wales |
| State: | FL US |
| Postal Code: | 33853 |
| Phone Number: | 8632325111 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2008 |
| NPI Last Update Date: | 12/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Health Information |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Preferred term for an Accredited Record Technician who is an individual with an associate |