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NPI Code Detail

MEDICARE: LOWER KEYS RADIOLOGY INC

MEDICARE: LOWER KEYS RADIOLOGY 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
12085R0204XVascular & Interventional Radiology Physician
22085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1336809557
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOWER KEYS RADIOLOGY INC
Provider Business Mailing Address
First Line : 2330 UTAH AVE STE 200
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-4817
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8375 DIX ELLIS TRL STE 201
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-8241
Country : US
Telephone Number : 904-399-5550
Fax Number : 904-346-4334
Authorized Official
Title or Position : VICE PRESIDENT
Name : SHARLEE LEBLEU
Credential :
Telephone Number : 480-321-7026
Provider Enumeration Date : 12/29/2021
Last Update Date : 07/12/2024

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Directions to “LOWER KEYS RADIOLOGY INC ” Practice Location

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