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General NPI Number Information
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NPI Number | 1043538655
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL RADIOLOGY CONSULTANTS, LLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 1717 N E ST SUITE 423
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City | PENSACOLA
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State | FL
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Zip | 32501-6339
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Country | US
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Telephone | 850-432-6851
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Fax | 850-438-6821
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Provider Business Mailing Address
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Address Line | 1717 N E ST SUITE 423
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City | PENSACOLA
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State | FL
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Zip | 32501-6339
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Country | US
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Telephone | 850-432-6851
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Fax | 850-438-6821
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. AMIT GIRISH GUPTA
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Credential | M.D.
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Telephone | 850-432-6851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0106X
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Taxonomy Name | Vascular-Interventional Technology Radiologic Technologist
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License Number |
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License Number State |
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