Organization
IRVING RADIOLOGY, INC
Active
Parent organization
IRVING RADIOLOGY, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
IRVING RADIOLOGY, INC
Authorized official
DR. WINSTON DACOSTA IRVING (OWNER)
(314) 935-0770
Entity
Organization
Contact information
Practice address
4011 S MONROE MEDICAL PARK BLVD, BLOOMINGTON, IN 47403
(239) 309-0602
Mailing address
13690 EAGLE RIDGE DR, FORT MYERS, FL 33912-1864
(239) 309-0602
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99119700A
—
IN
Enumeration date
07/28/2023
Last updated
07/18/2025
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