Organization
EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Active
Organization
EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Active
Other names
Twin Lakes Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AL FALCO (CEO)
(386) 274-7118
Entity
Organization
Contact information
Practice address
1890 LPGA BLVD, SUITE 110, DAYTONA BEACH, FL 32117-7130
(386) 274-7272
(386) 274-5440
Mailing address
1673 MASON AVE, SUITE 305, DAYTONA BEACH, FL 32117-5515
(386) 274-7118
(386) 274-6173
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2860
BLUE CROSS
FL
Enumeration date
07/06/2006
Last updated
02/08/2010
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