Healthcare Provider Details

I. General information

NPI: 1629404140
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF TAMPA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E BLOOMINGDALE AVE STE A
BRANDON FL
33511-8180
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-4100
  • Fax:
Mailing address:
  • Phone: 813-253-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY T SMITH
Title or Position: CEO
Credential:
Phone: 813-253-2721