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NPI Code Detail

MEDICARE: GAINESVILLE RADIOLOGY GROUP WEST, LLC

MEDICARE: GAINESVILLE RADIOLOGY GROUP WEST, 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
12085R0202XDiagnostic Radiology Physician256176FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V3013OTHERFLBCBS IDTF NUMBER EAST OFC
2V2766OTHERFLBCBS IDTF NUMBER

General Provider Information

NPI Number : 1508869405
Entity Type Code : Organization
Provider Name (Legal Business Name) : GAINESVILLE RADIOLOGY GROUP WEST, LLC
Provider Business Mailing Address
First Line : 4960 W NEWBERRY RD
Second Line : STE 280
City : GAINESVILLE
State : FL
Zip : 32607-2201
Country : US
Telephone Number : 352-371-3336
Fax Number : 352-371-3372
Provider Business Practice Location Address
First Line : 4960 W NEWBERRY RD
Second Line : STE 280
City : GAINESVILLE
State : FL
Zip : 32607-2201
Country : US
Telephone Number : 352-371-3336
Fax Number : 352-371-3372
Authorized Official
Title or Position : MANAGING MEMBER
Name : TONY ARVESU
Credential :
Telephone Number : 352-332-2040
Provider Enumeration Date : 05/24/2005
Last Update Date : 08/22/2020

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