Healthcare Provider Details

I. General information

NPI: 1386004901
Provider Name (Legal Business Name): PRECISION MEDICAL IMAGING AND THERAPEUTIC INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 GREEN FOREST LN SUITE #101
LUTZ FL
33558-5388
US

IV. Provider business mailing address

2540 GREEN FOREST LN SUITE #101
LUTZ FL
33558-5388
US

V. Phone/Fax

Practice location:
  • Phone: 813-920-5200
  • Fax:
Mailing address:
  • Phone: 813-920-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES OKOH
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 813-920-5200