FLORIDA DIAGNOSTIC IMAGING CENTER (NPI# 1356309074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356309074 |
| Entity Type | Organization |
| Organization Name | FLORIDA DIAGNOSTIC IMAGING CENTER |
| Other Organization Name | OPEN MRI OF FORT WALTON |
| Practice Address |
908 Mar Walt Dr Fort Walton Beach FL 32547-6706 |
| Mailing Address |
Po Box 933544 Atlanta GA 31193-3544 |
| Practice Telephone | 8508629394 |
| Practice Fax Number | 8508628533 |
| Mailing Telephone | 7703000101 |
| Mailing Fax Number | 7703000429 |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2013-09-23 |
| Authorized Official Name | MR. DANIEL J SCHAEFER (COO) |
| Authorized Official Telephone | 7703000101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS ALABAMA | 55303 | 01 |
| FL | BCBS FLORIDA | V2705 | 01 |
| FL | VISTA SUNRISE | SG076079 | 01 |
| FL | 262856200 | 05 | |
| FL | UNITED HEALTHCARE | 2403398 | 01 |
| FL | RR MEDICARE | 470000877 | 01 |
| FL | AETNA | 7168661 | 01 |
| Other Name | Type Code |
|---|---|
| Open MRI of Fort Walton | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043278831 | Florida Diagnostic Imaging Center | Radiology | 4536 E Highway 20, Niceville, FL 32578-9755 | 2006-05-02 |
| 1669555967 | Florida Diagnostic Imaging Center | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-10-23 |
| 1407814106 | Florida Diagnostic Imaging Center | Radiology | 16201 Panama City Beach Pkwy, Sutie 101, Panama City Beach, FL 32413-5301 | 2006-05-02 |
| 1750353629 | Florida Diagnostic Imaging Center | Radiology | 2457 Care Dr, Suite D-100, Tallahassee, FL 32308-4580 | 2006-02-06 |
| Street Address |
908 MAR WALT DR |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710522602 | Fort Walton Open Radiology, Pllc | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2019-11-14 |
| 1831595792 | Dolphin Radiology Pllc | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2014-11-05 |
| 1669555967 | Florida Diagnostic Imaging Center | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-10-23 |
| 1043264419 | Steven J Sukstorf | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| 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 |
|---|---|---|---|---|
| 1356983829 | North Florida Radiology Associates Pllc | Radiology | 1992 Lewis Turner Blvd, Fort Walton Beach, FL 32547-1255 | 2019-10-16 |
| 1356509038 | Tara Marie Otto | Radiology | 220 Fliva Ave Nw, Fort Walton Beach, FL 32548 | 2008-05-29 |
| 1285628743 | Vincent Thomas Jones | Radiology | 1005 Mar Walt Drive, Radiology Department, Fort Walton Beach, FL 32547-6796 | 2005-09-09 |
| 1710522602 | Fort Walton Open Radiology, Pllc | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2019-11-14 |
| 1831595792 | Dolphin Radiology Pllc | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2014-11-05 |
| 1750524393 | Coastal Radiology Associates Pa | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2009-04-13 |
| 1669555967 | Florida Diagnostic Imaging Center | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-10-23 |
| 1487626164 | Walter William Perrott | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2006-02-06 |
| 1164493235 | Bethany A Cazenave | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2006-01-27 |
| 1861463937 | Craig R Cazenave | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2006-01-27 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
Please comment or provide details below to improve the information on FLORIDA DIAGNOSTIC IMAGING CENTER.
| 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.