Fort Walton Diagnostic Imaging Center LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

HCC4489 Issued in FL

Legal business name

FORT WALTON DIAGNOSTIC IMAGING CENTER LLC

Practice address

1112 Hospital Rd
Suite C
Fort Walton Beach, FL 32547-6742

Phone

(850) 862-7070

Fax

(850) 862-0900

NPI assigned

May 19, 2006

Organization subpart

No

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

Authorized official

Name

Gary McMichael

Title

Member

Phone

(850) 862-7070

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1619920642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 HOSPITAL RD",
            "address_2": "SUITE C",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476742",
            "telephone_number": "850-862-7070",
            "fax_number": "850-862-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 HOSPITAL RD",
            "address_2": "SUITE C",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476742",
            "telephone_number": "850-862-7070",
            "fax_number": "850-862-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WALTON DIAGNOSTIC IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MCMICHAEL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "850-862-7070"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "FL",
            "license": "HCC4489",
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "HCC4489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL PROVIDER NO.",
            "identifier": "V2837",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NO.",
            "identifier": "7732283",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Walton Beach Medical Center, Inc. (HCA Florida Fort Walton-Destin Hospital)
• Fort Walton Beach Medical Center, Inc. (Physical Therapy at HCA Florida Fort Walton-Destin Hospital)
• Fort Walton Beach Medical Center, Inc. (Cardiac Rehabilitation at HCA Florida Fort Walton-Destin Hospital)
• Fort Walton Beach Medical Center, Inc. (HCA Florida Fort Walton-Destin Hospital)
• Fort Walton Beach Vision Center LLC (The VIsion Hub at Fort Walton Beach)
• Fort Walton Open Radiology, PLLC (Open MRI of Fort Walton)
• Fort Walton Rehabilitation Center, LLC
• David Fortner, L.M.H.C.
• Cierra Fortson
• Jennifer Lynn Fortune

• Radiology Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.