Healthcare Provider Details

I. General information

NPI: 1821503137
Provider Name (Legal Business Name): CENTRAL FLORIDA IMAGING SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S HARBOR CITY BLVD STE 100
MELBOURNE FL
32901-1968
US

IV. Provider business mailing address

PO BOX 400
MELBOURNE FL
32902-0400
US

V. Phone/Fax

Practice location:
  • Phone: 321-409-9900
  • Fax: 321-409-9990
Mailing address:
  • Phone: 321-409-9990
  • Fax:

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: MRS. LISA FAUCETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 321-409-9990