Healthcare Provider Details

I. General information

NPI: 1093964207
Provider Name (Legal Business Name): SOCA IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19621 COCHRAN BLVD STE 3
PT CHARLOTTE FL
33948-2043
US

IV. Provider business mailing address

8100 ROYAL PALM BLVD STE 102
CORAL SPRINGS FL
33065-5733
US

V. Phone/Fax

Practice location:
  • Phone: 941-629-9729
  • Fax: 941-627-8080
Mailing address:
  • Phone: 954-341-2325
  • Fax: 954-341-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC4109
License Number StateFL

VIII. Authorized Official

Name: MR. MILES E. GILMAN
Title or Position: PRESIDENT
Credential:
Phone: 305-665-1197