MEDICARE: SUNSHINE DIAGNOSTIC IMAGING, INC

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	261QR0208X	Mobile Radiology Clinic/Center	37218	FL
2	261QR0208X	Mobile Radiology Clinic/Center	CRT 33569	FL

General Provider Information

NPI Number	:	1265753271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE DIAGNOSTIC IMAGING, INC

Provider Business Mailing Address
First Line	:	4123 ARTHURIUM AVE
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3431
Country	:	US
Telephone Number	:	561-503-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4123 ARTHURIUM AVE
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3431
Country	:	US
Telephone Number	:	561-503-6331
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERSON RAYMOND
Credential	:	R.T., R.D.M.S.
Telephone Number	:	561-503-6331

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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