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General NPI Number Information
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NPI Number | 1821754847
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Entity Type | Organization
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Legal Business Name | ASM IMAGING SOURCES LLC
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 801 W BAY DR STE 506
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City | LARGO
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State | FL
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Zip | 33770-3278
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Country | US
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Telephone | 217-377-2949
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 ROSERY RD NW APT 4324
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City | LARGO
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State | FL
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Zip | 33770-1267
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Country | US
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Telephone | 217-377-2949
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Fax |
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Authorized Official
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Title or Position | ECHO TECH
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Name | ALTOVISE SHANNELL MOORER
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Credential |
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Telephone | 217-377-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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