Organization
RX IMAGING OF SWFL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN L TANNENBAUM M.D. (OWNER)
(239) 292-6669
Entity
Organization
Contact information
Practice address
506 SE 47TH TER, SUITE A, CAPE CORAL, FL 33904-8517
(239) 541-5444
(239) 471-2674
Mailing address
506 SE 47TH TER, SUITE A, CAPE CORAL, FL 33904-8517
(239) 541-5444
(239) 471-2674
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013199600
—
FL
01
—
10D2082062
CLIA CERTIFICATE OF WAIVER
FM
01
—
606072
HEALTH CARE CLINIC ESTABLISHMENT
FL
Enumeration date
06/30/2014
Last updated
02/20/2015
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