Healthcare Provider Details

I. General information

NPI: 1376947838
Provider Name (Legal Business Name): TRICOH DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12004 RACE TRACK RD
TAMPA FL
33626-3109
US

IV. Provider business mailing address

12004 RACE TRACK RD
TAMPA FL
33626-3109
US

V. Phone/Fax

Practice location:
  • Phone: 813-902-2640
  • Fax: 813-814-4080
Mailing address:
  • Phone: 813-902-2640
  • Fax: 813-814-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberME78386
License Number StateFL

VIII. Authorized Official

Name: MR. TODD ALLEN BLACKWOOD
Title or Position: OWNER
Credential:
Phone: 813-753-8598