MEDICARE: HEATHROW IMAGING LLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DN3311	OTHER	FL	RR MEDICARE

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
2	V3203	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1043416928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHROW IMAGING LLC

Provider Business Mailing Address
First Line	:	1343 SOUTH INTERNATIONAL PARKWAY
Second Line	:	SUITE 1351 BLDG 3
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1401
Country	:	US
Telephone Number	:	407-333-4464
Fax Number	:	407-333-4393

Provider Business Practice Location Address
First Line	:	1343 SOUTH INTERNATIONAL PARKWAY
Second Line	:	SUITE 1351 BLDG 3
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1401
Country	:	US
Telephone Number	:	407-333-4464
Fax Number	:	407-333-4393

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MR. LAVELLE R HARDIN
Credential	:
Telephone Number	:	615-344-8203

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	10/15/2009

Similar Medicare Providers

1154546935 — NATIONAL DRUG & ALCOHOL RECOVERY, INC
Practice Location Address:

1349 S INTERNATIONAL PKWY , SUITE 1401
LAKE MARY, FL
32746-1697

Practice Phone: 407-705-2564
Practice Fax: 407-829-8521

1316143332 — HEATHROW IMAGING LLC
Practice Location Address:

1343 S INTERNATIONAL PKWY , SUITE 1351 BLDG 3
LAKE MARY, FL
32746-1401

Practice Phone: 407-333-4464
Practice Fax: 407-333-4393

1487907010 — INTEGRATIVE PHYSICAL MEDICINE OF LAKE MARY LLC
Practice Location Address:

1343 S INTERNATIONAL PKWY , SUITE 1351-B
LAKE MARY, FL
32746-1401

Practice Phone: 407-792-0705
Practice Fax: 407-792-0710

1043637861 — INTEGRATIVE PHYSICAL MEDICINE OF LAKE MARY LLC
Practice Location Address:

1343 S INTERNATIONAL PKWY
LAKE MARY, FL
32746-1401

Practice Phone: 407-792-0705
Practice Fax: 407-792-0710

1902283138 — DR. SYDNEY GOODIJOHN
Practice Location Address:

1343 S INTERNATIONAL PKWY
LAKE MARY, FL
32746-1401

Practice Phone: 407-792-0705
Practice Fax:

1902262371 — CENTRAL FLORIDA IMAGING, LLC.
Practice Location Address:

1343 S INTERNATIONAL PKWY
LAKE MARY, FL
32746-1401

Practice Phone: 407-961-7250
Practice Fax: 407-961-7260

Directions to “HEATHROW IMAGING LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.