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General NPI Number Information
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NPI Number | 1760374292
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Entity Type | Organization
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Legal Business Name | IRVING RADIOLOGY, INC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 425 W 5TH ST
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-2405
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Country | US
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Telephone | 239-214-8187
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Fax |
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Provider Business Mailing Address
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Address Line | 13690 EAGLE RIDGE DR
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City | FORT MYERS
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State | FL
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Zip | 33912-1864
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Country | US
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Telephone | 239-214-8187
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Fax | 877-334-9599
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Authorized Official
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Title or Position | OWNER
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Name | DR. WINSTON DACOSTA IRVING
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Credential | MD
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Telephone | 646-725-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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