Provider Demographics
NPI:1336031871
Name:IRVING RADIOLOGY, INC
Entity type:Organization
Organization Name:IRVING RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:DACOSTA
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-214-8187
Mailing Address - Street 1:13690 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1864
Mailing Address - Country:US
Mailing Address - Phone:239-214-8187
Mailing Address - Fax:877-334-9599
Practice Address - Street 1:201 NW R D MIZE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2513
Practice Address - Country:US
Practice Address - Phone:239-214-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRVING RADIOLOGY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty