Healthcare Provider Details

I. General information

NPI: 1568419109
Provider Name (Legal Business Name): DIAGNOSTIC OUTPATIENT CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KURT ST
EUSTIS FL
32726-6234
US

IV. Provider business mailing address

2603 KURT ST
EUSTIS FL
32726-6234
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-6100
  • Fax: 352-483-6110
Mailing address:
  • Phone: 352-483-6100
  • Fax: 352-483-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LARRY J WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 727-896-2202