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General NPI Number Information
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NPI Number | 1730404542
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Entity Type | Organization
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Legal Business Name | HAPPY HEART IMAGING SERVICE
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 17820 SE 109TH AVE
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8968
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Country | US
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Telephone | 352-693-2340
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Fax | 352-693-2345
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Provider Business Mailing Address
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Address Line | 5131 SW 62ND AVE
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City | GAINESVILLE
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State | FL
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Zip | 32608-4848
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Country | US
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Telephone | 352-379-9395
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Fax | 352-375-2401
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Authorized Official
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Title or Position | OWNER
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Name | JOYCE ANN ELLIS
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Credential | CCPT
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Telephone | 352-379-9395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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