Provider Demographics
NPI:1538451919
Name:DIGITAL RADIOLOGY CENTER INC
Entity type:Organization
Organization Name:DIGITAL RADIOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-519-8947
Mailing Address - Street 1:1105 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5804
Mailing Address - Country:US
Mailing Address - Phone:407-519-8947
Mailing Address - Fax:407-536-4418
Practice Address - Street 1:1105 SUMNER ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5804
Practice Address - Country:US
Practice Address - Phone:407-519-8947
Practice Address - Fax:407-536-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL818652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263270500Medicaid
FL263270500Medicaid