MEDICARE: FLORIDA DIAGNOSTIC PORTABLE 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W9833	OTHER	FL	BLUE SHIELD XRAY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427051887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DIAGNOSTIC PORTABLE IMAGING, INC

Provider Business Mailing Address
First Line	:	5201 BABCOCK ST NE
Second Line	:	STE 2
City	:	PALM BAY
State	:	FL
Zip	:	32905-4637
Country	:	US
Telephone Number	:	321-984-8001
Fax Number	:	321-728-0523

Provider Business Practice Location Address
First Line	:	5201 BABCOCK ST NE
Second Line	:	STE 2
City	:	PALM BAY
State	:	FL
Zip	:	32905-4637
Country	:	US
Telephone Number	:	321-984-8001
Fax Number	:	321-728-0523

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRUCE D COTTI
Credential	:	R.T.(R)
Telephone Number	:	321-984-8001

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/05/2008

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Directions to “FLORIDA DIAGNOSTIC PORTABLE IMAGING, INC ” Practice Location

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