Healthcare Provider Details

I. General information

NPI: 1952772089
Provider Name (Legal Business Name): PUTNAM IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 ST. JOHNS AVE.
PALATKA FL
32177-3884
US

IV. Provider business mailing address

3426 NW 43RD ST SUITE B
GAINESVILLE FL
32606-8156
US

V. Phone/Fax

Practice location:
  • Phone: 386-202-4006
  • Fax: 386-385-5699
Mailing address:
  • Phone: 352-338-2089
  • Fax: 386-530-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME54477
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME64833
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME81873
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME54534
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2829
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2712
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2627
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME76357
License Number StateFL

VIII. Authorized Official

Name: PERINCHERY NARAYAN
Title or Position: PRESIDENT
Credential:
Phone: 352-338-2089