Healthcare Provider Details

I. General information

NPI: 1861729196
Provider Name (Legal Business Name): HOME CARE X-RAY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 TAMIAMI TRAIL S
VENICE FL
34285
US

IV. Provider business mailing address

PO BOX 4992
SEMINOLE FL
33775-4992
US

V. Phone/Fax

Practice location:
  • Phone: 877-972-9225
  • Fax:
Mailing address:
  • Phone: 877-972-9225
  • Fax: 877-972-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberHCC8533
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberHCC8533
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN COLON
Title or Position: PRESIDENT
Credential: CPA
Phone: 877-972-9225