Organization
FLORIDA DIAGNOSTIC PORTABLE IMAGING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE D COTTI R.T.(R) (OWNER)
(321) 984-8001
Entity
Organization
Contact information
Practice address
5201 BABCOCK ST NE, STE 2, PALM BAY, FL 32905-4637
(321) 984-8001
(321) 728-0523
Mailing address
5201 BABCOCK ST NE, STE 2, PALM BAY, FL 32905-4637
(321) 984-8001
(321) 728-0523
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030398400
—
FL
01
—
W9833
BLUE SHIELD XRAY
FL
Enumeration date
05/31/2005
Last updated
06/05/2008
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