Healthcare Provider Details

I. General information

NPI: 1881210565
Provider Name (Legal Business Name): RADIOLOGY CONSULTANTS OF HOLLYWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9822 TAPESTRY PARK CIR STE 201
JACKSONVILLE FL
32246-9260
US

IV. Provider business mailing address

210 S FEDERAL HWY STE 403
HOLLYWOOD FL
33020-6811
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-1776
  • Fax:
Mailing address:
  • Phone: 954-929-3400
  • Fax: 954-929-2001

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: MARK GRNJA
Title or Position: PRESIDENT
Credential:
Phone: 954-929-3400