Organization
FLORIDA DIAGNOSTIC IMAGING CENTER
Active
Organization
FLORIDA DIAGNOSTIC IMAGING CENTER
Active
Other names
Blue Water Diagnostic Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL J SCHAEFER (COO)
(770) 300-0101
Entity
Organization
Contact information
Practice address
4536 E HIGHWAY 20, NICEVILLE, FL 32578-9755
(850) 729-6747
(850) 729-7279
Mailing address
3480 PRESTON RIDGE RD STE 600, CREDENTIALING DEPT, ALPHARETTA, GA 30005-5462
(770) 300-0101
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2403386
UNITED HEALTHCARE
FL
05
—
262856200
—
FL
01
—
470000878
RR MEDICARE
FL
01
—
7228598
AETNA
FL
01
—
SG076082
VISTA SUNRISE
FL
01
—
V2732
BCBS FLORIDA
FL
Enumeration date
05/02/2006
Last updated
09/23/2013
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