=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528473402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX IMAGING OF SWFL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2014
-----------------------------------------------------
Last Update Date | 02/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 SE 47TH TER SUITE A
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-8517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-541-5444
-----------------------------------------------------
Fax | 239-471-2674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 SE 47TH TER SUITE A
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-8517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-541-5444
-----------------------------------------------------
Fax | 239-471-2674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALAN L TANNENBAUM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 239-292-6669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------