FORT WALTON DIAGNOSTIC IMAGING CENTER LLC NPI 1619920642

NPI Information

NPI: 1619920642
Provider Name: FORT WALTON DIAGNOSTIC IMAGING CENTER LLC
Classification: Clinic/Center - 261QM1300X
Specialization: Multi-Specialty
Entity Type: Organization
Address: 1112 HOSPITAL RD
SUITE C
FORT WALTON BEACH, FL
ZIP 32547
Phone: (850) 862-7070

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NPI Details

FORT WALTON DIAGNOSTIC IMAGING CENTER LLC is a multi-specialty clinic center in Fort Walton Beach, FL. FORT WALTON DIAGNOSTIC IMAGING CENTER LLC NPI is 1619920642. The provider is registered as an organization entity type.

The provider's business location address is:

1112 HOSPITAL RD
SUITE C
FORT WALTON BEACH, FL
ZIP 32547-742
Phone: (850) 862-7070
Fax: (850) 862-0900

The provider's authorized official is Gary Mcmichael .
The authorized official title is Member and has the following contact phone number (850) 862-7070.

The enumeration date for this NPI number is 5/19/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty	HCC4489	FLORIDA	Yes
2	261QR0200X	Clinic/Center	Radiology	HCC4489	FLORIDA	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	V2837	OTHER	FLORIDA	BCBS FL PROVIDER NO.
2	7732283	OTHER	FLORIDA	AETNA PROVIDER NO.

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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