Healthcare Provider Details

I. General information

NPI: 1114254976
Provider Name (Legal Business Name): INTEGRATED MEDICAL DIAGNOSTICS, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2009
Last Update Date: 11/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5523 RAWLS RD
TAMPA FL
33625-1324
US

IV. Provider business mailing address

5523 RAWLS RD
TAMPA FL
33625-1324
US

V. Phone/Fax

Practice location:
  • Phone: 877-343-2783
  • Fax: 888-376-9730
Mailing address:
  • Phone: 877-343-2783
  • Fax: 888-376-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAEB JANNOUN
Title or Position: PRESIDENT
Credential:
Phone: 877-343-2783