Provider Demographics
NPI:1487794186
Name:RAINA IMAGING, INC.
Entity type:Organization
Organization Name:RAINA IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:904-992-9749
Mailing Address - Street 1:245 LAND GRANT ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1698
Mailing Address - Country:US
Mailing Address - Phone:904-992-9749
Mailing Address - Fax:904-992-8980
Practice Address - Street 1:245 LAND GRANT ST UNIT 6
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1698
Practice Address - Country:US
Practice Address - Phone:904-992-9749
Practice Address - Fax:904-212-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALI3794261QR0208X
261QR0208X
FLHCC6547261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL470000610OtherRAILROAD MEDICARE PIN
FL498797OtherWELLCARE
FL950001085OtherRAILROAD MEDICARE PIN
FLV2104OtherBC/BS PIN
FLV2104OtherBC/BS PIN
FL498797OtherWELLCARE