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NPI Code Detail

MEDICARE: NEUROSKELETAL IMAGING LLC

MEDICARE: NEUROSKELETAL 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
12085R0202XDiagnostic Radiology Physician
22085R0202XDiagnostic Radiology PhysicianFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639163975
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROSKELETAL IMAGING LLC
Provider Business Mailing Address
First Line : PO BOX 400
Second Line :
City : MELBOURNE
State : FL
Zip : 32902-0400
Country : US
Telephone Number : 321-409-9990
Fax Number : 321-956-2165
Provider Business Practice Location Address
First Line : 709 S HARBOR CITY BLVD STE 100
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1936
Country : US
Telephone Number : 321-409-9990
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : LISA FAUCETT
Credential :
Telephone Number : 321-409-9990
Provider Enumeration Date : 09/01/2005
Last Update Date : 04/23/2024

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Directions to “NEUROSKELETAL IMAGING LLC ” Practice Location

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