Healthcare Provider Details

I. General information

NPI: 1922737725
Provider Name (Legal Business Name): RADIOLOGY REGIONAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 HOPE CENTER LOOP
FORT MYERS FL
33912
US

IV. Provider business mailing address

3660 BROADWAY
FORT MYERS FL
33901-8005
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-4068
  • Fax: 239-936-6989
Mailing address:
  • Phone: 239-936-2316
  • Fax: 239-834-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDOLPH J KNIFIC
Title or Position: CEO
Credential: MD
Phone: 239-936-2316