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Organization
FLORIDA DIAGNOSTIC IMAGING INC
Active
Organization
FLORIDA DIAGNOSTIC IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN LANDIS DO (PRESIDENT)
(321) 676-5323
Entity
Organization
Contact information
Practice address
5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL 32905-4637
(321) 676-5323
(321) 951-9253
Mailing address
5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL 32905-4637
(321) 676-5323
(321) 951-9253
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5282
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0782103
CIGNA
FL
01
—
102370
AVMED
FL
01
—
1209448
FIRST HEALTH/MAIL HANDLER
FL
01
—
1488395
UNITED HEALTHCARE
FL
01
—
16-00554
UNITEDHEALTHCARE MEDIPASS
FL
01
—
17030
STAYWELL/WELLCARE
FL
01
—
288660
AMERIGROUP
FL
01
—
40016
FLORIDIANCARE
FL
01
—
8208068
AETNA
FL
01
—
FDA 155978
EMBRACED PROGRAM
FL
01
—
OS0004065
WORKERS COMPENSATION
FL
01
—
V2489
BCBS OF FLORIDA
FL
Enumeration date
04/13/2006
Last updated
12/13/2007
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