Healthcare Provider Details

I. General information

NPI: 1750538906
Provider Name (Legal Business Name): MUSCULOSKELETAL INSTITUTE CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S LAKEWOOD DR STE 101
BRANDON FL
33511-5015
US

IV. Provider business mailing address

13020 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0925
US

V. Phone/Fax

Practice location:
  • Phone: 813-657-8448
  • Fax:
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-972-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberJR28873000
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberMRAP02641-02
License Number StateFL

VIII. Authorized Official

Name: DR. ROY W SANDERS
Title or Position: PRESIDENT
Credential: MD
Phone: 813-978-9700