Healthcare Provider Details

I. General information

NPI: 1790954535
Provider Name (Legal Business Name): MUSCULOSKELETAL INSTITUTE CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0925
US

IV. Provider business mailing address

13020 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0925
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax: 813-972-5055
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-972-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberMRAP02641-02
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberJR2887300
License Number StateFL

VIII. Authorized Official

Name: DR. ROY W SANDERS
Title or Position: PRESIDENT
Credential: MD
Phone: 813-978-9700