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General NPI Number Information
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NPI Number | 1578018305
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Entity Type | Organization
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Legal Business Name | MRI ASSOCIATES OF BRANDON, LLC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 403 S KINGS AVE STE 200R
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City | BRANDON
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State | FL
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Zip | 33511-5905
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Country | US
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Telephone | 813-210-8995
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Fax | 813-409-2914
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Provider Business Mailing Address
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Address Line | 403 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-5905
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Country | US
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Telephone | 813-210-8995
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Fax | 813-409-2914
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Authorized Official
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Title or Position | CAO
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Name | AMANDA MAPLE
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Credential |
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Telephone | 727-787-6900
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCC10828
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License Number State | FL
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