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General NPI Number Information
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NPI Number | 1306848825
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Entity Type | Organization
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Legal Business Name | MILLENNIUM IMAGING, INC.
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10910 E STATE ROAD 70 SUITE 103
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City | BRADENTON
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State | FL
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Zip | 34202-8406
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Country | US
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Telephone | 941-755-5257
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Fax | 941-755-4856
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Provider Business Mailing Address
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Address Line | PO BOX 11440
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City | BRADENTON
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State | FL
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Zip | 34282-1440
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Country | US
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Telephone | 941-755-5257
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Fax | 941-755-4856
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH E LADIKA JR
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Credential | R.T., C.V.T.
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Telephone | 941-755-5257
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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 | HCC5297
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License Number State | FL
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