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General NPI Number Information
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NPI Number | 1295862605
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Entity Type | Organization
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Legal Business Name | HENDRY DIAGNOSTIC IMAGING CENTER
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 1008 W SAGAMORE AVE
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City | CLEWISTON
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State | FL
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Zip | 33440-3420
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Country | US
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Telephone | 863-983-1103
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Fax | 863-983-0307
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Provider Business Mailing Address
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Address Line | PO BOX 151908
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City | CAPE CORAL
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State | FL
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Zip | 33915-1908
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Country | US
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Telephone | 239-242-5237
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Fax | 239-242-7274
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Authorized Official
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Title or Position | DIRECTOR
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Name | VICTOR C BASILE
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Credential |
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Telephone | 863-983-1103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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