Healthcare Provider Details

I. General information

NPI: 1235197930
Provider Name (Legal Business Name): FLORIDA DIAGNOSTIC IMAGING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 N DAVIS HWY SUITE 1-B
PENSACOLA FL
32503-2720
US

IV. Provider business mailing address

1642 WESTGATE CIR STE 202
BRENTWOOD TN
37027-8195
US

V. Phone/Fax

Practice location:
  • Phone: 850-484-8454
  • Fax: 850-484-7754
Mailing address:
  • Phone: 615-713-7519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAIF ERIM
Title or Position: COO
Credential:
Phone: 615-713-7519