Healthcare Provider Details

I. General information

NPI: 1033120977
Provider Name (Legal Business Name): QUALITY VASCULAR IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 WOODMERE PARK BLVD SUITE 8B
VENICE FL
34293-5373
US

IV. Provider business mailing address

4120 WOODMERE PARK BLVD SUITE 8B
VENICE FL
34293-5373
US

V. Phone/Fax

Practice location:
  • Phone: 941-408-8855
  • Fax: 941-408-8955
Mailing address:
  • Phone: 941-408-8855
  • Fax: 941-408-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JEAN M WHITE
Title or Position: PRESIDENT
Credential: RVT
Phone: 941-408-8855