Organization
HEATHROW IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE R HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
1343 SOUTH INTERNATIONAL PARKWAY, SUITE 1351 BLDG 3, LAKE MARY, FL 32746-1401
(407) 333-4464
(407) 333-4393
Mailing address
1343 SOUTH INTERNATIONAL PARKWAY, SUITE 1351 BLDG 3, LAKE MARY, FL 32746-1401
(407) 333-4464
(407) 333-4393
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001115600
—
FL
01
—
DN3311
RR MEDICARE
FL
01
—
V3203
BCBS OF FL
FL
Enumeration date
06/26/2007
Last updated
10/15/2009
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