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General NPI Number Information
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NPI Number | 1265481451
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Entity Type | Organization
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Legal Business Name | RADIOLOGY CONSULTANTS IMAGING CENTER LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 400 AVENUE K SE BUILDING 4
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4146
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Country | US
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Telephone | 863-292-0297
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Fax | 863-292-0327
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Provider Business Mailing Address
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Address Line | 400 AVENUE K SE BUILDING 4
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4146
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Country | US
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Telephone | 863-292-0297
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Fax | 863-292-0327
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. RONALD BRINSKO
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Credential | M.D.
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Telephone | 863-292-0297
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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 | JR4036000
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License Number State | FL
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