Healthcare Provider Details

I. General information

NPI: 1114202827
Provider Name (Legal Business Name): PASCO IMAGING CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

PO BOX 20627
TAMPA FL
33622-0627
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-5640
  • Fax:
Mailing address:
  • Phone: 813-899-6220
  • Fax: 813-985-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLIS B NORSOPH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-899-6220