Organization
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Active
Parent organization
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Other names
SOUTHSIDE OFFICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Authorized official
EDWARD J GOODEMOTE PHD, RN (CEO)
(863) 577-0303
Entity
Organization
Contact information
Practice address
3021 LAKELAND HIGHLANDS RD, STE 3, LAKELAND, FL 33803-4339
(863) 688-2334
(863) 577-1167
Mailing address
2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
(866) 804-7649
(614) 764-9147
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V0068
BCBS FL
FL
Enumeration date
02/03/2012
Last updated
11/03/2016
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