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Contact Information

SOUTHEAST RADIOLOGY ASSOCIATES PL
340 NW COMMERCE DR
LAKE CITY, FL32055-4709
 Phone: 386-719-9000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Body Imaging

2085B0100X
 

Diagnostic Ultrasound

2085U0001X
 

Neuroradiology

2085N0700X
 

Nuclear Radiology

2085N0904X
 

Pediatric Radiology

2085P0229X
 

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
Indicates primary specialty

NPI Profile & details for SOUTHEAST RADIOLOGY ASSOCIATES PL

NPI Number 1467409631
LBN Legal business name SOUTHEAST RADIOLOGY ASSOCIATES PL
Authorized official JOHN DETELICH - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/31/2006
Last updated 10/17/2007 - About 19 years ago
Identifiers
FL Other 97561 BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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