Healthcare Provider Details

I. General information

NPI: 1972518405
Provider Name (Legal Business Name): MRI ASSOCIATES OF ST PETE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 94TH AVE N STE 206
ST PETERSBURG FL
33702-2453
US

IV. Provider business mailing address

750 94TH AVE N STE 206
ST PETERSBURG FL
33702-2453
US

V. Phone/Fax

Practice location:
  • Phone: 727-577-2220
  • Fax: 727-578-6452
Mailing address:
  • Phone: 727-577-2220
  • Fax: 727-578-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC3960
License Number StateFL

VIII. Authorized Official

Name: MS. KIMBERLY MAHONEY
Title or Position: OWNER
Credential:
Phone: 727-577-2220