Healthcare Provider Details

I. General information

NPI: 1285631002
Provider Name (Legal Business Name): ULTRA IMAGING OF TAMPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W ROBERTSON ST
BRANDON FL
33511-5111
US

IV. Provider business mailing address

123 W ROBERTSON ST
BRANDON FL
33511-5111
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-9674
  • Fax: 813-681-0944
Mailing address:
  • Phone: 813-681-9674
  • Fax: 813-681-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SAMUEL HANKINS JR.
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 615-344-2274