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General NPI Number Information
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NPI Number | 1255416129
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Entity Type | Organization
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Legal Business Name | NORTH TAMPA IMAGING LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 14302 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33613-2601
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Country | US
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Telephone | 813-975-1111
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Fax | 813-975-0555
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Provider Business Mailing Address
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Address Line | 14302 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33613-2601
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Country | US
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Telephone | 813-975-1111
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Fax | 813-975-0555
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Authorized Official
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Title or Position | CREDENTIALING & ENROLLMENT
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Name | MR. LAVELLE HARDIN
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Credential |
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Telephone | 615-344-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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