FORT WALTON DIAGNOSTIC IMAGING CENTER LLC (NPI# 1619920642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619920642 |
| Entity Type | Organization |
| Organization Name | FORT WALTON DIAGNOSTIC IMAGING CENTER LLC |
| Practice Address |
1112 Hospital Rd Suite C Fort Walton Beach FL 32547-6742 |
| Practice Telephone | 8508627070 |
| Practice Fax Number | 8508620900 |
| Mailing Telephone | 8508627070 |
| Mailing Fax Number | 8508620900 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GARY MCMICHAEL (MEMBER) |
| Authorized Official Telephone | 8508627070 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
HCC4489 | FL | Ambulatory Health Care Facilities |
| X | 261QR0200X |
Clinic/Center Specialization: Radiology |
HCC4489 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS FL PROVIDER NO. | V2837 | 01 |
| FL | AETNA PROVIDER NO. | 7732283 | 01 |
| Street Address |
1112 HOSPITAL RD SUITE C |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205804432 | Okaloosa Walton Urology Pa | Urology | 1112 Hospital Rd, Unit A, Fort Walton Beach, FL 32547-6655 | 2006-03-14 |
| 1528584745 | Hampton Dialysis LLC | Clinic/Center | 1112 Hospital Rd, Fort Walton Beach, FL 32547-6742 | 2017-08-18 |
| 1497958466 | Navarre Open Mri LLC | Clinic/Center | 1112 Hospital Rd, Suite B, Fort Walton Beach, FL 32547-6742 | 2007-06-07 |
| 1992757678 | Ft Walton Open Mri LLC | Clinic/Center | 1112 Hospital Rd, Suite B, Fort Walton Beach, FL 32547-6742 | 2006-05-17 |
| 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 | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
Please comment or provide details below to improve the information on FORT WALTON DIAGNOSTIC IMAGING CENTER LLC.
| 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.