MEDICARE: RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND PA

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	V3035	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1013280361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND PA

Provider Business Mailing Address
First Line	:	PO BOX 20027
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-0027
Country	:	US
Telephone Number	:	866-804-7649
Fax Number	:	614-210-1886

Provider Business Practice Location Address
First Line	:	1121 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4655
Country	:	US
Telephone Number	:	863-688-2334
Fax Number	:	863-577-1167

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTIAN T SCHMITT
Credential	:	MD
Telephone Number	:	863-688-2334

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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