Healthcare Provider Details

I. General information

NPI: 1346202017
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF TAMPA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR RADIOLOGY ASSOC OF TAMPA AT TAMPA GENERAL HOSPITAL
TAMPA FL
33606-3571
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR RAT AT TAMPA GENERAL HOSPITAL
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7444
  • Fax: 813-844-4144
Mailing address:
  • Phone: 813-251-5822
  • Fax: 813-254-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 813-251-5822