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1427049931

NPI Code Detail

MEDICARE: RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND

MEDICARE: RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND

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		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	CC6469	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00584	OTHER	FL	BCBS OF FLORIDA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427049931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND

Provider Business Mailing Address
First Line	:	PO BOX 20027
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-0027
Country	:	US
Telephone Number	:	866-804-7649
Fax Number	:	614-764-9147

Provider Business Practice Location Address
First Line	:	2115 CRYSTAL GROVE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6875
Country	:	US
Telephone Number	:	863-688-2334
Fax Number	:	863-577-0301

Authorized Official
Title or Position	:	CEO
Name	:	MR. EDWARD J GOODEMOTE
Credential	:	PHD, RN
Telephone Number	:	863-688-2334

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	01/17/2023

Similar Medicare Providers

1447773502 — DR. BRADLEY W BARTEL JR. DC
Practice Location Address:

2125 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-701-2225
Practice Fax: 863-701-2221

1457342727 — DR. CHARLEY T. MYRICK III D. O.
Practice Location Address:

2125 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-688-2334
Practice Fax: 863-577-0299

1568435915 — DR. MARY T GRIFFEN MD
Practice Location Address:

2125 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-688-2334
Practice Fax: 863-577-0301

1154531887 — SARA SAFDER M.D.
Practice Location Address:

2125 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-688-2334
Practice Fax:

1003013848 — DR. KEVIN JAMES SAWYER M.D.
Practice Location Address:

2125 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-688-2334
Practice Fax:

1447439575 — LAWRENCE R WHITNEY III M.D.
Practice Location Address:

2115 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-688-2334
Practice Fax:

Directions to “RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND ” Practice Location

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