Healthcare Provider Details

I. General information

NPI: 1831563568
Provider Name (Legal Business Name): UP-STANDING RADIOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 N 9TH AVE SUITE 120
PENSACOLA FL
32504-8756
US

IV. Provider business mailing address

PO BOX 11982
PENSACOLA FL
32524-1982
US

V. Phone/Fax

Practice location:
  • Phone: 850-912-8847
  • Fax: 850-665-3631
Mailing address:
  • Phone: 850-912-8847
  • Fax: 850-665-3631

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: AARON BRYANT MONTGOMERY
Title or Position: OWNER
Credential: MD
Phone: 850-912-8847