Organization
TALLAHASSEE DIAGNOSTIC IMAGING LTD
Active
Parent organization
TALLAHASSEE DIAGNOSTIC IMAGING LTD
Other names
Tallahassee Diagnostic Imaging (TDI)
Organization subpart
Yes
Provider details
NPI number
Legal business name
TALLAHASSEE DIAGNOSTIC IMAGING LTD
Authorized official
CARA FOWLER (CEO)
(850) 671-6412
Entity
Organization
Contact information
Practice address
15 COUNCIL MOORE RD, CRAWFORDVILLE, FL 32327-3117
(850) 926-1259
(850) 926-1679
Mailing address
PO BOX 13551, TALLAHASSEE, FL 32317-3551
(850) 878-4102
(850) 942-4155
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
2471C3401X
Computed Tomography Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062730501
—
FL
01
—
V3086
BCBS
FL
Enumeration date
05/22/2006
Last updated
10/17/2007
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