MEDICARE: ORMOND RADIOLOGY PARTNERSHIP, L.L.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG5244	OTHER	FL	RR MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	V3001	OTHER	FL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1053377861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORMOND RADIOLOGY PARTNERSHIP, L.L.C

Provider Business Mailing Address
First Line	:	500 MEMORIAL CIR
Second Line	:	SUITE B
City	:	OMROND BEACH
State	:	FL
Zip	:	32174-5054
Country	:	US
Telephone Number	:	386-673-8040
Fax Number	:	386-267-0693

Provider Business Practice Location Address
First Line	:	1680 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4754
Country	:	US
Telephone Number	:	386-304-1212
Fax Number	:	386-304-4432

Authorized Official
Title or Position	:	HUMAN RESOURCES/CREDENTIALING
Name	:	MS. JT TENER
Credential	:
Telephone Number	:	386-673-8040

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	12/12/2007

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Directions to “ORMOND RADIOLOGY PARTNERSHIP, L.L.C ” Practice Location

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