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General NPI Number Information
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NPI Number | 1285690099
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Entity Type | Organization
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Legal Business Name | ORMOND RADIOLOGY PARTNERSHIP, L.L.C.
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 500 MEMORIAL CIR SUITE E-2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5054
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Country | US
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Telephone | 386-673-7056
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Fax | 386-673-7815
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Provider Business Mailing Address
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Address Line | 500 MEMORIAL CIR SUITE B
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5054
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Country | US
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Telephone | 386-673-8040
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Fax | 386-267-0693
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Authorized Official
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Title or Position | HUMAN RESOURCES/CREDENTIALING
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Name | MS. JT TENER
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Credential |
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Telephone | 386-673-8070
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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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