Organization
LAD IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM B. RUTHERFORD (SENIOR VP)
(615) 309-2190
Entity
Organization
Contact information
Practice address
1555 SAXON BLVD, STE 401, DELTONA, FL 32725-5861
(386) 532-0094
(386) 532-0451
Mailing address
1555 SAXON BLVD, STE 401, DELTONA, FL 32725-5861
(386) 532-0094
(386) 532-0451
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280837400
—
FL
01
—
V3036
BCBS OF FL
FL
Enumeration date
10/27/2005
Last updated
08/31/2011
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