NPIMap

Organization Active NPI

Florida Radiology Imaging at Lake Mary, LLC

Doing business as AdventHealth Imaging Altamonte

  • Diagnostic Radiology Physician
  • Altamonte Springs, FL
National Provider Identifier
1437615770
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC
Doing business as
AdventHealth Imaging Altamonte
Practice address
661 E Altamonte Dr Ste 130
Altamonte Springs, FL 32701-5102
Phone
(407) 303-2155
Fax
(407) 303-2165
NPI assigned
Feb 12, 2019
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Michael Edward Mazeres
Title
VP/Cfo
Phone
(407) 200-5403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

661 E Altamonte Dr Ste 130
Altamonte Springs, FL 32701-5102

Mailing address

900 Winderley PL Ste 2100
Maitland, FL 32751-4191
Phone (407) 303-2155

Other names 1

  • AdventHealth Imaging Altamonte Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Florida Radiology LLC12 organizations share this tax ID, including this one
Part of
Florida Radiology LLC

Other organizations with this tax ID 11

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

Locations

616 E Altamonte Dr
Ste 130
Altamonte Springs, FL 32701
Phone (407) 303-2155

NPI Registry JSON

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1437615770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WINDERLEY PL STE 2100",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514191",
            "telephone_number": "407-303-2155",
            "fax_number": "407-303-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 E ALTAMONTE DR STE 130",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327015102",
            "telephone_number": "407-303-2155",
            "fax_number": "407-303-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC",
        "enumeration_date": "2019-02-12",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MAZERES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "407-200-5403"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Imaging Altamonte",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Altamonte Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.