MEDICARE: SOUTH BAY 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

General Provider Information

NPI Number	:	1427009018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY IMAGING, LLC

Provider Business Mailing Address
First Line	:	4051 UPPER CREEK DR
Second Line	:	SUITE 103
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 UPPER CREEK DR
Second Line	:	SUITE 103
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6825
Country	:	US
Telephone Number	:	813-634-8329
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SAM HANKINS
Credential	:
Telephone Number	:	813-634-8329

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/22/2020

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