RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA (NPI# 1235401480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235401480 |
| Entity Type | Organization |
| Organization Name | RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA |
| Other Organization Name | SOUTHSIDE OFFICE |
| Practice Address |
3021 Lakeland Highlands Rd Ste 3 Lakeland FL 33803-4339 |
| Mailing Address |
2125 Crystal Grove Dr Lakeland FL 33801-6875 |
| Practice Telephone | 8636882334 |
| Practice Fax Number | 8635771167 |
| Mailing Telephone | 8668047649 |
| Mailing Fax Number | 6147649147 |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2016-11-03 |
| Authorized Official Name | EDWARD J GOODEMOTE (CEO) |
| Authorized Official Telephone | 8635770303 |
| Authorized Official Credential | PHD, RN |
| Is Organization Subpart | Y |
| Parent Organization Name | RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS FL | V0068 | 01 |
| Other Name | Type Code |
|---|---|
| SOUTHSIDE OFFICE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124530761 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 313 W Bass St, Kissimmee, FL 34741-5011 | 2017-11-03 |
| 1669744801 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 206 W Alexander St, Ste 1, Plant City, FL 33563-7100 | 2012-02-03 |
| 1295342087 | Radiology & Imaging Specialists of Lakeland, Pa | Pain Medicine | 205 N Plant Ave, Plant City, FL 33563-4731 | 2020-09-25 |
| 1063032993 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 1417 Lakeland Hills Blvd Ste 104, Lakeland, FL 33805-3200 | 2020-04-21 |
| 1073151064 | Radiology & Imaging Specialists of Lakeland, Pa | Surgery | 320 1st St N, Winter Haven, FL 33881-4113 | 2019-12-20 |
| 1851803407 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2017-11-03 |
| 1326404195 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 130 Pablo St, Lakeland, FL 33803-3818 | 2016-01-11 |
| 1750654000 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 2120 Lakeland Hills Blvd, Lakeland, FL 33805-2906 | 2012-02-17 |
| 1649543992 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 1305 Lakeland Hills Blvd, Lakeland, FL 33805-4542 | 2012-02-17 |
| 1558634816 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 2120 Lakeland Hills Blvd, Lakeland, FL 33805-2906 | 2012-02-17 |
| Street Address |
3021 LAKELAND HIGHLANDS RD STE 3 |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803-4339 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124026844 | Community Rehab & Wellness Inc | Physical Therapist | 3021 Lakeland Highlands Rd, Lakeland, FL 33803-4339 | 2005-07-08 |
| 1508286329 | Michael Nagib | Radiology | 3021 Lakeland Highlands Rd, Lakeland, FL 33803-4339 | 2014-04-19 |
| 1700944212 | Rayanne Woodruff | Speech-Language Pathologist | 3021 Lakeland Highlands Rd, Lakeland, FL 33803-4339 | 2006-12-05 |
| 1417933227 | Elsa K Nail | Physical Therapist | 3021 Lakeland Highlands Rd, Community Rehab and Wellness, Lakeland, FL 33803-4339 | 2005-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
| Find all providers in zip 33803 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013280361 | Radiology & Imaging Specialists of Lakeland Pa | Radiology | 1121 Lakeland Hills Blvd, Lakeland, FL 33805-4655 | 2012-02-17 |
| 1427049931 | Radiology & Imaging Specialists of Lakeland | Radiology | 2125 Crystal Grove Dr, Lakeland, FL 33801-6875 | 2005-11-03 |
| 1063032993 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 1417 Lakeland Hills Blvd Ste 104, Lakeland, FL 33805-3200 | 2020-04-21 |
| 1851803407 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2017-11-03 |
| 1487180659 | Central Florida Imaging of Lakeland LLC | Radiology | 1205 East Magnolia St, Suite 109, Lakeland, FL 33801 | 2017-05-10 |
| 1326404195 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 130 Pablo St, Lakeland, FL 33803-3818 | 2016-01-11 |
| 1427493931 | Tadeusz Ciszak | Radiology | 1305 Lakeland Hills Blvd, Lakeland, FL 33805-4542 | 2013-05-10 |
| 1750654000 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 2120 Lakeland Hills Blvd, Lakeland, FL 33805-2906 | 2012-02-17 |
| 1649543992 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 1305 Lakeland Hills Blvd, Lakeland, FL 33805-4542 | 2012-02-17 |
| 1558634816 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 2120 Lakeland Hills Blvd, Lakeland, FL 33805-2906 | 2012-02-17 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.