MEDICARE: INTELLIRAD IMAGING, 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	:	1578362240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTELLIRAD IMAGING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 7623
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34101-7623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7458 PINE FOREST RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-8818
Country	:	US
Telephone Number	:	850-494-4600
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	RONALD JOSEPH
Credential	:
Telephone Number	:	305-712-7229

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/13/2025

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