Healthcare Provider Details

I. General information

NPI: 1043538655
Provider Name (Legal Business Name): INTERVENTIONAL RADIOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1717 N E ST SUITE 423
PENSACOLA FL
32501-6339
US

IV. Provider business mailing address

1717 N E ST SUITE 423
PENSACOLA FL
32501-6339
US

V. Phone/Fax

Practice location:
  • Phone: 850-432-6851
  • Fax: 850-438-6821
Mailing address:
  • Phone: 850-432-6851
  • Fax: 850-438-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIT GIRISH GUPTA
Title or Position: VICE-PRESIDENT
Credential: M.D.
Phone: 850-432-6851