Healthcare Provider Details

I. General information

NPI: 1972820546
Provider Name (Legal Business Name): US RADIOLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 NIGHTINGALE LANE SUITE A1
TAVARES FL
32708
US

IV. Provider business mailing address

1879 NIGHTINGALE LANE SUITE A1
TAVARES FL
32708
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: CANDY PAQUETTE
Title or Position: MANAGER
Credential:
Phone: 352-401-1919