Healthcare Provider Details

I. General information

NPI: 1821396342
Provider Name (Legal Business Name): INTERVENTIONAL RADIOLOGY ASSOCIATES OF TAMPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 UNIVERSITY SQUARE DR INTERVENTIONAL RADIOLOGY ASSOC OF TAMPA LLC
TAMPA FL
33612-5513
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR INTERVENTIONAL RADIOLOGY ASSOC OF TAMPA LLC
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-2721
  • Fax: 813-253-2299
Mailing address:
  • Phone: 813-253-2721
  • Fax: 813-253-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC6551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberHCC6551
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL LOMBARDI
Title or Position: BILLING DIRECTOR
Credential:
Phone: 813-253-2721