MEDICARE: ALTEC DIAGNOSTICS & IMAGING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013087865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTEC DIAGNOSTICS & IMAGING INC

Provider Business Mailing Address
First Line	:	5562 SPRING PARK RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5549
Country	:	US
Telephone Number	:	904-854-6741
Fax Number	:	631-517-8007

Provider Business Practice Location Address
First Line	:	5562 SPRING PARK RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5549
Country	:	US
Telephone Number	:	904-854-6741
Fax Number	:	904-425-3144

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. GARY WRIGHT
Credential	:
Telephone Number	:	813-675-2439

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	05/07/2012

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