Healthcare Provider Details

I. General information

NPI: 1518907823
Provider Name (Legal Business Name): FLORIDA RADIOLOGY LEASING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/13/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 S POINTE BLVD STE 600
FORT MYERS FL
33919-4901
US

IV. Provider business mailing address

6311 S POINTE BLVD STE 600
FORT MYERS FL
33919-4901
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9150
  • Fax: 239-343-9159
Mailing address:
  • Phone: 239-234-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberNA
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberNA
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberNA
License Number StateFL

VIII. Authorized Official

Name: MR. BENJAMIN SPENCE
Title or Position: CFO
Credential:
Phone: 239-343-6513