MEDICARE: MID-FLORIDA IMAGING SERVICES 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	261QR0200X	Radiology Clinic/Center	54687	FL
2	293D00000X	Physiological Laboratory	54687	FL
3	261QR0208X	Mobile Radiology Clinic/Center	54687	FL

General Provider Information

NPI Number	:	1396841805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-FLORIDA IMAGING SERVICES LLC

Provider Business Mailing Address
First Line	:	24103 HARBECK LANE
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-8112
Country	:	US
Telephone Number	:	407-788-0455
Fax Number	:	407-389-0931

Provider Business Practice Location Address
First Line	:	24103 HARBECK LANE
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-8112
Country	:	US
Telephone Number	:	407-788-0455
Fax Number	:	407-389-0931

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHAD WESTON HALL
Credential	:	RDMS,RVT,RDCS
Telephone Number	:	407-788-0455

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/21/2022

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