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General NPI Number Information
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NPI Number | 1235313057
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Entity Type | Organization
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Legal Business Name | SUGAR MILL DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 8303 S SUNCOAST BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-5028
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Country | US
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Telephone | 352-628-9900
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Fax | 352-628-9700
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Provider Business Mailing Address
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Address Line | 8303 S SUNCOAST BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-5028
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Country | US
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Telephone | 352-628-9900
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Fax | 352-628-9700
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL KEITH HERRON
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Credential | M.D.
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Telephone | 352-795-6909
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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 | ME84779
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | N/A
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License Number State | FL
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