MEDICARE: NORTH BRANDON IMAGING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0206X	Mammography Clinic/Center
3	261QR0200X	Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00280433	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
2	V3028	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1649276098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BRANDON IMAGING LLC

Provider Business Mailing Address
First Line	:	613 OAKFIELD DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5714
Country	:	US
Telephone Number	:	813-661-2222
Fax Number	:	813-681-8494

Provider Business Practice Location Address
First Line	:	613 OAKFIELD DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5714
Country	:	US
Telephone Number	:	813-661-2222
Fax Number	:	813-681-8494

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	10/09/2008

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Directions to “NORTH BRANDON IMAGING LLC ” Practice Location

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