Organization
LAD 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
1193 SOUTH WOODLAND BLVD, DELAND, FL 32720-7416
(386) 574-5748
(386) 574-0712
Mailing address
1193 SOUTH WOODLAND BLVD, DELAND, FL 32720-7416
(386) 574-5748
(386) 574-0712
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
—
280838200
—
FL
01
—
V2977
BCBS OF FL
FL
Enumeration date
10/31/2005
Last updated
10/09/2008
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