Healthcare Provider Details

I. General information

NPI: 1740033695
Provider Name (Legal Business Name): GULF ISLANDS MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ROYCE ST
PENSACOLA FL
32503-2464
US

IV. Provider business mailing address

910 ROYCE ST
PENSACOLA FL
32503-2464
US

V. Phone/Fax

Practice location:
  • Phone: 448-202-1580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TENA WRIGHT
Title or Position: OWNER
Credential: RT (R)(CT)(M)(BD)
Phone: 448-202-1580