=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841245727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA FLUOROSCOPY SERVICES LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 09/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1471 CADES BAY AVE
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-630-6277
-----------------------------------------------------
Fax | 561-630-6062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1471 CADES BAY AVE
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-630-6277
-----------------------------------------------------
Fax | 561-630-6062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | MR. HAROLD STACY SCROGGINS
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 561-630-6277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------