Organization
OPEN MRI OF ORLANDO INC
Active
Other names
Lakeside Open MRI of Tavares
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN P WOODBURN (PRESIDENT)
(352) 742-9211
Entity
Organization
Contact information
Practice address
1879 NIGHTINGALE LN, SUITE A-1, TAVARES, FL 32778-4363
(352) 742-9211
(352) 742-9406
Mailing address
1879 NIGHTINGALE LN, SUITE A-1, TAVARES, FL 32778-4363
(352) 742-9211
(352) 742-9406
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5152
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2544
BLUE CROSS AND BLUE SHEIL
FL
Enumeration date
06/06/2006
Last updated
08/22/2020
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