NPIMap

Organization Active NPI

Tallahassee Diagnostic Imaging Center, LTD

  • Diagnostic Radiology Physician
  • Tallahassee, FL
National Provider Identifier
1255087680
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
TALLAHASSEE DIAGNOSTIC IMAGING CENTER, LTD
Practice address
2459 Mahan Dr
Tallahassee, FL 32308-2307
Phone
(850) 878-4127
NPI assigned
Feb 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
John R Detelich
Title
Ceo
Phone
(850) 878-4127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2459 Mahan Dr
Tallahassee, FL 32308-2307

Mailing address

PO Box 21348
Tampa, FL 33622-1348
Phone (800) 475-6112

National Provider Directory

National Provider Directory
Tax ID family
Tallahassee Diag Imaging Ctr LTD4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2459 Mahan Dr
Tallahassee, FL 32308

NPI Registry JSON

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1255087680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21348",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336221348",
            "telephone_number": "800-475-6112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2459 MAHAN DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323082307",
            "telephone_number": "850-878-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE DIAGNOSTIC IMAGING CENTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "DETELICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-878-4127"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.