Organization
NEW SMYRNA DIAGNOSTIC IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AL FALCO (CHIEF OPERATING OFFICER)
(386) 274-7118
Entity
Organization
Contact information
Practice address
401 PALMETTO ST, NEW SMYRNA BEACH, FL 32168-7322
(386) 424-5140
Mailing address
PO BOX 2240, DAYTONA BEACH, FL 32115-2240
(386) 255-9120
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
98142
BLUE CROSS
FL
Enumeration date
08/11/2006
Last updated
08/22/2020
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