Healthcare Provider Details

I. General information

NPI: 1477620060
Provider Name (Legal Business Name): FLORIDA RADIOLOGY MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 CARLTON ST
WAUCHULA FL
33873-3407
US

IV. Provider business mailing address

PO BOX 150340
ALTAMONTE SPRINGS FL
32715-0340
US

V. Phone/Fax

Practice location:
  • Phone: 863-773-3101
  • Fax:
Mailing address:
  • Phone: 407-767-0433
  • Fax: 407-767-0608

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: CHARLES MAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 407-767-5306