Healthcare Provider Details

I. General information

NPI: 1144210477
Provider Name (Legal Business Name): LAD IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SAXON BLVD STE 401
DELTONA FL
32725-5861
US

IV. Provider business mailing address

1555 SAXON BLVD STE 401
DELTONA FL
32725-5861
US

V. Phone/Fax

Practice location:
  • Phone: 386-532-0094
  • Fax: 386-532-0451
Mailing address:
  • Phone: 386-532-0094
  • Fax: 386-532-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM B. RUTHERFORD
Title or Position: SENIOR VP
Credential:
Phone: 615-309-2190