Healthcare Provider Details

I. General information

NPI: 1134459720
Provider Name (Legal Business Name): RADIANCE RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37566 US HIGHWAY 19 N
PALM HARBOR FL
34684-1019
US

IV. Provider business mailing address

37566 US HIGHWAY 19 N
PALM HARBOR FL
34684-1019
US

V. Phone/Fax

Practice location:
  • Phone: 727-815-2423
  • Fax: 727-330-7760
Mailing address:
  • Phone: 727-815-2423
  • Fax: 727-330-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCRT73617
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberCRT73617
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANDREY SALAMAKHA
Title or Position: PRESIDENT
Credential: R.T. (R)
Phone: 727-815-2423