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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