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General NPI Number Information
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NPI Number | 1104106582
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Entity Type | Organization
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Legal Business Name | LARGO RADIOLOGY CONSULTANTS, PA
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 201 14TH ST SW
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City | LARGO
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State | FL
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Zip | 33770-3133
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Country | US
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Telephone | 727-588-5200
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Fax | 813-985-8006
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Provider Business Mailing Address
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Address Line | PO BOX 22467
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City | TAMPA
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State | FL
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Zip | 33622-2467
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Country | US
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Telephone | 813-899-6220
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Fax | 813-985-8006
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ELLIS B. NORSOPH
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Credential | MD
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Telephone | 813-899-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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