10D2123738 CLIA NUMBER - SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING LONGWOOD

Laboratory Demographics

CLIA Number: 10D2123738

Facility Name: SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING LONGWOOD

Facility Address:
225 W SR 434 STE 103, 104
LONGWOOD, FL
ZIP 32750
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Facility Phone Number: 480 584-5508

Facility Type: Other - MEDICAL OUTPATIENT RADIOL

Certificate Type: Waiver

NPI Number: 1033789011

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D2123738
LAB Type	Other - MEDICAL OUTPATIENT RADIOL
Facility Name	SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING LONGWOOD
Street	225 W SR 434 STE 103, 104
City	LONGWOOD
State	FL
ZIP	32750
Phone	480 584-5508
CertificateType	4
CertificateEffectiveDate	12/30/2022
CertificateExpirationDate	12/29/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024