Lake Wales Medical Imaging Center One, Inc

Primary specialty

Health Information TechnicianTaxonomy code 247000000X

Legal business name

LAKE WALES MEDICAL IMAGING CENTER ONE, INC

Practice address

1255 Highway 60 East 110
Lake Wales, FL 33853

Phone

(863) 232-5111

NPI assigned

Dec 8, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kollagunta Chandrasekhar

Title

President

Phone

(863) 232-5111

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1063657955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 LONGLEAF BLVD SUITE 200",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "33859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 60 EAST 110",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "33853",
            "telephone_number": "863-232-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES MEDICAL IMAGING CENTER ONE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "CHANDRASEKHAR",
        "authorized_official_first_name": "KOLLAGUNTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-232-5111",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "247000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Health Information",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Wales Foot and Ankle Care, Inc
• Lake Wales Healthcare LLC (Grace Healthcare of Lake Wales)
• Lake Wales Hospital Corporation (Lake Wales Medical Center)
• Lake Wales Hospital Corporation (Lake Wales Medical Center)
• Lake Wales Medial Center
• Lake Wales Medical Walk in Clinic PA
• Lake Wales Operating Group LLC
• Lake Wales Physician Services, LLC
• Lake Wales Primary Care Center, LLC
• Lake Wales SLC Opco LLC (The Club at Lakes Wales)

• Health Information Technician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Health Information Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.