Provider Demographics
NPI:1669997961
Name:SW FLORIDA RADIOLOGY LLC
Entity type:Organization
Organization Name:SW FLORIDA RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-770-6408
Mailing Address - Street 1:3949 EVANS AVE STE 301B
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9313
Mailing Address - Country:US
Mailing Address - Phone:239-214-0633
Mailing Address - Fax:239-204-2063
Practice Address - Street 1:3949 EVANS AVE STE 301B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9313
Practice Address - Country:US
Practice Address - Phone:239-214-0633
Practice Address - Fax:239-204-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1063132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty