10D2231601 CLIA NUMBER - INSTITUTE OF DIAGNOSTIC IMAGING, THE

Laboratory Demographics

CLIA Number: 10D2231601

Facility Name: INSTITUTE OF DIAGNOSTIC IMAGING, THE

Facility Address:
424 RACETRACK ROAD NW
FORT WALTON BEACH, FL
ZIP 32547
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Facility Phone Number: 850 314-7575

Facility Type: Other - OUTPATIEN DIAGNOSTIC IMAG

Certificate Type: Waiver

NPI Number: 1982670022

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	10D2231601
LAB Type	Other - OUTPATIEN DIAGNOSTIC IMAG
Facility Name	INSTITUTE OF DIAGNOSTIC IMAGING, THE
Street	424 RACETRACK ROAD NW
City	FORT WALTON BEACH
State	FL
ZIP	32547
Phone	850 314-7575
CertificateType	4
CertificateEffectiveDate	8/4/2023
CertificateExpirationDate	8/3/2025
FacilityType	Waiver

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