Organization
FLORIDA DIAGNOSTIC IMAGING CENTER
Active
Organization
FLORIDA DIAGNOSTIC IMAGING CENTER
Active
Other names
Open MRI of Fort Walton
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL J SCHAEFER (COO)
(770) 300-0101
Entity
Organization
Contact information
Practice address
908 MAR WALT DR, FORT WALTON BEACH, FL 32547-6706
(850) 862-9394
(850) 862-8533
Mailing address
PO BOX 933544, ATLANTA, GA 31193-3544
(770) 300-0101
(770) 300-0429
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2403398
UNITED HEALTHCARE
FL
05
—
262856200
—
FL
01
—
470000877
RR MEDICARE
FL
01
—
55303
BCBS ALABAMA
FL
01
—
7168661
AETNA
FL
01
—
SG076079
VISTA SUNRISE
FL
01
—
V2705
BCBS FLORIDA
FL
Enumeration date
05/02/2006
Last updated
09/23/2013
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