Healthcare Provider Details

I. General information

NPI: 1629194923
Provider Name (Legal Business Name): FLORIDA EAST COAST IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 PORT ST JOHN PKWY
PORT ST JOHN FL
32927-4305
US

IV. Provider business mailing address

PO BOX 15659
CLEARWATER FL
33766-5659
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-9393
  • Fax:
Mailing address:
  • Phone: 727-793-9300
  • 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: JOSEPH FLYNN
Title or Position: PRESIDENT
Credential:
Phone: 727-793-9300