MEDICARE: SIMONMED IMAGING FLORIDA 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	261QR0207X	Mobile Mammography Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
15	DS5839	OTHER	FL	RAILROAD 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	FW240	OTHER	FL	SIMONMED IMAGING OCOEE II
3	FW240A	OTHER	FL	SIMONMED IMAGING SUN CITY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	FW240	OTHER	FL	SIMONMED IMAGING POINCIANA
8	FW240	OTHER	FL	SIMONMED IMAGING LAKE MARY II
9	FW240	OTHER	FL	SIMONMED IMAGING LONGWOOD
10	FW240	OTHER	FL	SIMONMED IMAGING CLERMONT
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	FW240	OTHER	FL	SIMONMED IMAGING TAMPA
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477830818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMONMED IMAGING FLORIDA LLC

Provider Business Mailing Address
First Line	:	6900 E CAMELBACK RD STE 700
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2400
Country	:	US
Telephone Number	:	480-306-6949
Fax Number	:	602-302-5706

Provider Business Practice Location Address
First Line	:	14302 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2601
Country	:	US
Telephone Number	:	813-979-7580
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	HOWARD JOHN SIMON
Credential	:	MD
Telephone Number	:	602-809-6623

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	08/03/2022

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