Healthcare Provider Details

I. General information

NPI: 1699011841
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF TAMPA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL SARASOTA MEMORIAL HOSPITAL
SARASOTA FL
34239-3509
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-9000
  • Fax:
Mailing address:
  • Phone: 813-253-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberHCC6551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberHCC6551
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberHCC6551
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberHCC6551
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberHCC6551
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC6551
License Number StateFL

VIII. Authorized Official

Name: LARRY T SMITH
Title or Position: CEO
Credential:
Phone: 813-253-2721