Organization
SUMMERLIN IMAGING CENTER LLC
Active
Other names
Summerlin Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADFORD PETERS (CFO)
(561) 331-0808
Entity
Organization
Contact information
Practice address
20 BARKLEY CIR, SUITE 104, FT MYERS, FL 33907-4545
(239) 425-0370
(239) 425-0380
Mailing address
6415 LAKE WORTH RD STE 102, GREENACRES, FL 33463-3009
(561) 331-0808
(561) 237-6034
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
HCC4472
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2882
BCBS PROVIDER #
FL
Enumeration date
05/16/2006
Last updated
08/25/2020
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