LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC
NPI 1104495324
Radiology - Diagnostic Radiology in The Villages, FL

Q: What is Lake Medical Imaging And Breast Center At The Villages LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Active since June 22, 2021CLIA 10D2055116 · Waiver

1400 N US HIGHWAY 441 STE 510, THE VILLAGES, FL 32159(352) 787-5858(352) 787-4655 Get Directions Write a Review

NPPES record last updated: June 23, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Lake Medical Imaging And Breast Center At The Villages Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC (NPI 1104495324) is a healthcare organization registered as a diagnostic radiology in The Villages, Florida and active in the NPI registry since June 2021. The organization holds a CLIA Waiver certificate valid through March 5, 2027 and lists Joshua Lee Floyd, Director, Risk Management, as its authorized official.

NPPES Registry Identity

NPI1104495324

Entity TypeOrganization

Primary Taxonomy2085R0202X

Legal Business NameLAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC

Location Address1400 N US HIGHWAY 441 STE 510The Villages, FL 32159-8983

Mailing Address734 N 3rd St Ste 115Leesburg, FL 34748-5287 · (352) 365-2583 · Fax (352) 728-6749

Phone(352) 787-5858

Fax(352) 787-4655

Organization SubpartNo

Authorized OfficialJoshua Lee FloydDirector, Risk Management · (365) 352-2583

Enumeration DateJune 22, 2021

Last NPPES UpdateJune 23, 2021

NPPES CertifiedJune 23, 2021

✔ NPI 1104495324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians

Taxonomy Code2085R0202X

Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

1400 N US HIGHWAY 441 STE 510, The Villages, FL 32159

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Other Identifiers 1

Medicaid101183200FL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2055116

Lake Medical Imaging And Breast Center At The Villages · The Villages, FL

Active · expires Mar 5, 2027

CLIA Number10D2055116

Laboratory TypeImaging Center

Certificate Effective DateMarch 6, 2025

Certificate Expiration DateMarch 5, 2027

Laboratory DirectorKady Martin

Laboratory Phone(352) 435-6864

Laboratory LocationLake Medical Imaging And Breast Center At The Villages1400 Us Hwy 441 N Ste 510, The Villages, FL 32159

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. MARTA E HEABERLIN M.D.

Radiology (Diagnostic Radiology)

1400 N US HIGHWAY 441 STE 510
THE VILLAGES, FL 32159

Lake County (352) 787-5858

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Medical Imaging And Breast Center At The Villages LLC's NPI number?

The NPI number for Lake Medical Imaging And Breast Center At The Villages LLC is 1104495324. It was assigned to this organization in the NPPES registry on June 22, 2021.

Where is Lake Medical Imaging And Breast Center At The Villages LLC located?

Lake Medical Imaging And Breast Center At The Villages LLC is located at 1400 N Us Highway 441 Ste 510, The Villages, FL 32159. The listed phone number is (352) 787-5858.

What is Lake Medical Imaging And Breast Center At The Villages LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Does Lake Medical Imaging And Breast Center At The Villages LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2055116) is associated with this NPI, valid through March 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake Medical Imaging And Breast Center At The Villages LLC was last updated on June 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.