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General NPI Number Information
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NPI Number | 1316143332
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Entity Type | Organization
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Legal Business Name | HEATHROW IMAGING LLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1343 S INTERNATIONAL PKWY SUITE 1351 BLDG 3
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City | LAKE MARY
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State | FL
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Zip | 32746-1401
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Country | US
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Telephone | 407-333-4464
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Fax | 407-333-4393
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Provider Business Mailing Address
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Address Line | 1343 SOUTH INTERNATIONAL PARKWAY SUITE 1351 BLDG 3
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City | LAKE MARY
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State | FL
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Zip | 32746
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Country | US
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Telephone | 407-333-4464
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Fax | 407-333-4393
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MR. LAVELLE R HARDIN
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Credential |
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Telephone | 615-344-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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