Organization
SUMMERLIN IMAGING CENTER LLC
Active
Organization
SUMMERLIN IMAGING CENTER LLC
Active
Other names
Park Avenue Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADFORD PETERS (CFO)
(561) 331-0808
Entity
Organization
Contact information
Practice address
2128 PARK AVE, ORANGE PARK, FL 32073
(904) 375-8884
(904) 375-8887
Mailing address
6415 LAKE WORTH RD STE 102, GREENACRES, FL 33463-3009
(561) 331-0808
(561) 237-6034
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC10650
AHCC LICENSE
FL
Enumeration date
09/14/2016
Last updated
08/25/2020
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