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General NPI Number Information
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NPI Number | 1518907823
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Entity Type | Organization
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Legal Business Name | FLORIDA RADIOLOGY LEASING LLC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 6311 S POINTE BLVD STE 600
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City | FORT MYERS
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State | FL
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Zip | 33919-4901
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Country | US
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Telephone | 239-343-9150
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Fax | 239-343-9159
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Provider Business Mailing Address
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Address Line | 6311 S POINTE BLVD STE 600
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City | FORT MYERS
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State | FL
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Zip | 33919-4901
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Country | US
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Telephone | 239-234-3391
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. BENJAMIN SPENCE
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Credential |
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Telephone | 239-343-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | NA
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | NA
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | NA
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License Number State | FL
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