MEDICARE: NORTH TAMPA IMAGING LLC

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
2	P00273453	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	V3026	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1255416129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TAMPA IMAGING LLC

Provider Business Mailing Address
First Line	:	14302 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2601
Country	:	US
Telephone Number	:	813-975-1111
Fax Number	:	813-975-0555

Provider Business Practice Location Address
First Line	:	14302 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2601
Country	:	US
Telephone Number	:	813-975-1111
Fax Number	:	813-975-0555

Authorized Official
Title or Position	:	CREDENTIALING & ENROLLMENT
Name	:	MR. LAVELLE HARDIN
Credential	:
Telephone Number	:	615-344-8203

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/17/2009

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Directions to “NORTH TAMPA IMAGING LLC ” Practice Location

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