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

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

General Provider Information

NPI Number	:	1760055768
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	:	800-475-6112
Fax Number	:	706-653-1230

Provider Business Practice Location Address
First Line	:	200 AVENUE F NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4131
Country	:	US
Telephone Number	:	863-688-2334
Fax Number	:	706-653-1230

Authorized Official
Title or Position	:	CFO
Name	:	JOHN BARRETT
Credential	:
Telephone Number	:	863-688-2334

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	03/03/2026

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