Physicians Imaging-Mt Dora LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

PHYSICIANS IMAGING-MT DORA LLC

Practice address

3615 Lake Center Dr
Mount Dora, FL 32757-2364

Phone

(352) 383-3716

Fax

(352) 383-7457

NPI assigned

Apr 18, 2007

Last updated

Dec 19, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elias J Gerth, M.D.

Title

Operating Manager

Phone

(305) 295-1242

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1629294681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4610",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706064610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 LAKE CENTER DR",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572364",
            "telephone_number": "352-383-3716",
            "fax_number": "352-383-7457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS IMAGING-MT DORA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "GERTH",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPERATING MANAGER",
        "authorized_official_telephone_number": "305-295-1242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kira Peters
• Thien-an Thi Pham, PHARM D.
• Christopher John Phillips, MD
• Imani Akanne Phillips, BA, RBT
• Gritchalach Phophutthaprasit, AP, DOM
• Physicians of Central Florida, LLC (Physicians of Central Florida, PA)
• Steven Eugene Pillow, MD
• Adriana Nesta Pinkerton, PTA
• William Plum, MD
• Guadalupe Lizeth Polanco, LMT

• Radiology Clinic/Center in Mount Dora, FL
• Providers in Mount Dora, 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 Dec 19, 2007; 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.