MEDICARE: RADIOLOGY IMAGING ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1386415594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY IMAGING ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 161997
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32716-1997
Country	:	US
Telephone Number	:	352-671-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 E SILVER SPRINGS BLVD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-4903
Country	:	US
Telephone Number	:	352-723-6911
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CALEB RUBEN RIVERA
Credential	:	MD
Telephone Number	:	352-671-4221

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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