MEDICARE: FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085B0100X	Body Imaging Physician
2	2085N0700X	Neuroradiology Physician
3	2085N0904X	Nuclear Radiology Physician
4	2085P0229X	Pediatric Radiology Physician
5	2085R0204X	Vascular & Interventional Radiology Physician
6	2085U0001X	Diagnostic Ultrasound Physician
7	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V2517	OTHER	FL	BCBS LK MARY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CK2813	OTHER		RR MEDIARE - GROUP NUMBER

General Provider Information

NPI Number	:	1740256494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC

Provider Business Mailing Address
First Line	:	900 HOPE WAY
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1502
Country	:	US
Telephone Number	:	407-200-2355
Fax Number	:	407-767-0608

Provider Business Practice Location Address
First Line	:	960 RINEHART RD STE 1000
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1561
Country	:	US
Telephone Number	:	855-241-2455
Fax Number	:

Authorized Official
Title or Position	:	COO/VP
Name	:	RACHNA ATWAL
Credential	:
Telephone Number	:	407-200-4658

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	11/08/2024

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