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Organization

FLORIDA DIAGNOSTIC IMAGING INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. IAN LANDIS DO (PRESIDENT)
(321) 676-5323
Entity
Organization

Contact information

Practice address
5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL 32905-4637
(321) 676-5323
(321) 951-9253
Mailing address
5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL 32905-4637
(321) 676-5323
(321) 951-9253

Taxonomy

Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5282
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0782103
CIGNA
FL
01
102370
AVMED
FL
01
1209448
FIRST HEALTH/MAIL HANDLER
FL
01
1488395
UNITED HEALTHCARE
FL
01
16-00554
UNITEDHEALTHCARE MEDIPASS
FL
01
17030
STAYWELL/WELLCARE
FL
01
288660
AMERIGROUP
FL
01
40016
FLORIDIANCARE
FL
01
8208068
AETNA
FL
01
FDA 155978
EMBRACED PROGRAM
FL
01
OS0004065
WORKERS COMPENSATION
FL
01
V2489
BCBS OF FLORIDA
FL
Enumeration date
04/13/2006
Last updated
12/13/2007
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