Organization
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND
Active
Organization
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD J GOODEMOTE PHD, RN (CEO)
(863) 688-2334
Entity
Organization
Contact information
Practice address
2115 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
(863) 688-2334
(863) 577-0301
Mailing address
PO BOX 20027, TAMPA, FL 33622-0027
(866) 804-7649
(614) 764-9147
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00584
BCBS OF FLORIDA
FL
05
—
045292100
—
FL
05
—
045292101
—
FL
05
—
045292103
—
FL
05
—
045292104
—
FL
05
—
045292105
—
FL
05
—
045292106
—
FL
05
—
045292107
—
FL
01
—
CC6469
RR MEDICARE
FL
Enumeration date
11/03/2005
Last updated
01/17/2023
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