Organization
SAND LAKE IMAGING LLLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN C HOLMAN (SR. DIRECTOR, RCM)
(866) 674-7933
Entity
Organization
Contact information
Practice address
9350 TURKEY LAKE RD, ORLANDO, FL 32819-7319
(407) 363-2772
(407) 745-2844
Mailing address
PO BOX 161527, ALTAMONTE SPRINGS, FL 32716-1527
(866) 674-7933
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD2395
RAILROAD MEDICARE
—
01
—
V2904
BC BS OF FLORIDA
FL
Enumeration date
11/19/2005
Last updated
01/14/2022
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