Healthcare Provider Details

I. General information

NPI: 1033292891
Provider Name (Legal Business Name): MID FLORIDA RADIOLOGY CENTERS P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 TOWN CENTER DR SUITE 200
ORANGE CITY FL
32763-8255
US

IV. Provider business mailing address

955 TOWN CENTER DR SUITE 200
ORANGE CITY FL
32763-8255
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-1612
  • Fax: 386-775-1289
Mailing address:
  • Phone: 386-775-1612
  • Fax: 386-775-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME75332
License Number StateFL

VIII. Authorized Official

Name: AJAY KUMAR VERMA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 386-775-1612