Healthcare Provider Details

I. General information

NPI: 1477752319
Provider Name (Legal Business Name): GPSI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 TAMPA AVE W
VENICE FL
34285-1729
US

IV. Provider business mailing address

258 TAMPA AVE W
VENICE FL
34285-1729
US

V. Phone/Fax

Practice location:
  • Phone: 941-223-4282
  • Fax: 941-531-4318
Mailing address:
  • Phone: 941-223-4282
  • Fax: 941-531-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC7746
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN COLON
Title or Position: CEO
Credential: CPA
Phone: 941-966-7125