Healthcare Provider Details

I. General information

NPI: 1801889902
Provider Name (Legal Business Name): MRI-SOUTH UMBERTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 66TH ST
PINELLAS PARK FL
33781-5030
US

IV. Provider business mailing address

551 N CATTLEMEN RD 202
SARASOTA FL
34232-6444
US

V. Phone/Fax

Practice location:
  • Phone: 727-548-6736
  • Fax: 727-548-0947
Mailing address:
  • Phone: 941-926-6228
  • Fax: 941-371-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC3688
License Number StateFL

VIII. Authorized Official

Name: BELINDA HOLMES
Title or Position: MANAGER
Credential:
Phone: 941-365-4617