Healthcare Provider Details

I. General information

NPI: 1841298361
Provider Name (Legal Business Name): TRANSFLORIDA MOBILE DIAGNOSTIC SERVICES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S ORLANDO AVE SUITE F
WINTER PARK FL
32789-4869
US

IV. Provider business mailing address

805 S ORLANDO AVE SUITE F
WINTER PARK FL
32789-4869
US

V. Phone/Fax

Practice location:
  • Phone: 888-929-2224
  • Fax: 877-972-9327
Mailing address:
  • Phone: 888-929-2224
  • Fax: 877-972-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberHCC3857
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberHCC3857
License Number StateFL

VIII. Authorized Official

Name: MR. DONALD PYLES
Title or Position: PRESIDENT
Credential: R. T. (R.)
Phone: 888-929-2224