Provider Demographics
NPI:1295919025
Name:DIAGNOSTIC PORTABLE IMAGING INC
Entity type:Organization
Organization Name:DIAGNOSTIC PORTABLE IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COTTI
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)ARRT
Authorized Official - Phone:321-984-8001
Mailing Address - Street 1:5201 BABCOCK ST NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4637
Mailing Address - Country:US
Mailing Address - Phone:321-984-8001
Mailing Address - Fax:321-728-0523
Practice Address - Street 1:5201 BABCOCK ST NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4637
Practice Address - Country:US
Practice Address - Phone:321-984-8001
Practice Address - Fax:321-728-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV1919OtherBLUE SHIELD IDTF
FLV1919OtherBLUE SHIELD IDTF