Healthcare Provider Details

I. General information

NPI: 1871732842
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF TAMPA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13813 METRO PKWY
FORT MYERS FL
33912-4343
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-1343
  • Fax: 813-253-2299
Mailing address:
  • Phone: 813-251-5822
  • Fax: 813-253-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberHCC6551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberHCC6551
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberHCC6551
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberHCC6551
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberHCC6551
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberHCC6551
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberHCC6551
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC6551
License Number StateFL

VIII. Authorized Official

Name: MR. LARRY SMITH
Title or Position: CEO
Credential:
Phone: 813-251-5822