Healthcare Provider Details

I. General information

NPI: 1407278765
Provider Name (Legal Business Name): HERNANDO RADIOLOGY CONSULTANTS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10461 QUALITY DR
SPRING HILL FL
34609-9634
US

IV. Provider business mailing address

100 S ASHLEY DR SUITE 1500
TAMPA FL
33602-5304
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-8200
  • Fax:
Mailing address:
  • Phone: 813-899-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLIS B NORSOPH
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 813-899-6223