# STAND-UP MRI OF LAKELAND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811257876
- **Authorized official:** EDWARD J. GOODEMOTE RN, PHD (CEO)
- **Authorized official phone:** (863) 577-0303

## Contact information

- **Practice address:** 1121 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4655
- **Practice address phone:** (863) 688-2334
- **Practice address fax:** (863) 577-0301
- **Mailing address:** 2120 LAKELAND HILLS BLVD, LAKELAND, FL 33805-2906
- **Mailing address phone:** (863) 688-2334
- **Mailing address fax:** (863) 577-0301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | FL | Yes |

## Other

- **Enumeration date:** 05/24/2012
- **Last updated:** 05/24/2012