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	2085R0202X	Diagnostic Radiology Physician

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

General Provider Information

NPI Number	:	1740850684
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	:	1915 ALOMA AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3212
Country	:	US
Telephone Number	:	321-203-5710
Fax Number	:

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

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	02/03/2022

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