Healthcare Provider Details

I. General information

NPI: 1518280635
Provider Name (Legal Business Name): PARTNERS IMAGING CENTER OF VENICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 SUNSET LAKE BLVD STE 301
VENICE FL
34292-7552
US

IV. Provider business mailing address

848 N RAINBOW BLVD STE 2494
LAS VEGAS NV
89107-1103
US

V. Phone/Fax

Practice location:
  • Phone: 941-441-0060
  • Fax: 941-441-0070
Mailing address:
  • Phone: 877-700-1093
  • Fax: 877-484-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC10459
License Number StateFL

VIII. Authorized Official

Name: MITCHELL GEISLER
Title or Position: CEO
Credential:
Phone: 647-288-1508