10D2163353 CLIA NUMBER - SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING HUNTERS CREEK

Laboratory Demographics

CLIA Number: 10D2163353

Facility Name: SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING HUNTERS CREEK

Facility Address:
1125 MIRANDA LN
KISSIMMEE, FL
ZIP 34744
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Facility Phone Number: 480 428-5601

Facility Type: Other - OUTPATIENT MEDICAL IMAGIN

Certificate Type: Waiver

NPI Number: 1790354983

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	10D2163353
LAB Type	Other - OUTPATIENT MEDICAL IMAGIN
Facility Name	SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING HUNTERS CREEK
Street	1125 MIRANDA LN
City	KISSIMMEE
State	FL
ZIP	34744
Phone	480 428-5601
CertificateType	4
CertificateEffectiveDate	3/13/2023
CertificateExpirationDate	3/12/2025
FacilityType	Waiver

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