Healthcare Provider Details

I. General information

NPI: 1225015357
Provider Name (Legal Business Name): PRESGAR IMAGING OF ROCKLEDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 ROCKLEDGE BLVD SUITE 101
ROCKLEDGE FL
32955-3722
US

IV. Provider business mailing address

23110 STATE RD 54 PMB 292
LUTZ FL
33549-2921
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-1600
  • Fax: 321-633-0433
Mailing address:
  • Phone: 352-578-2055
  • Fax: 813-971-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberHCC5110
License Number StateFL

VIII. Authorized Official

Name: ROBBIE ROBERTSON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 813-323-2594