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General NPI Number Information
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NPI Number | 1912013897
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Entity Type | Organization
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Legal Business Name | SUN COAST IMAGING CENTER LLC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1951 INDIAN ROCKS RD S
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City | LARGO
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State | FL
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Zip | 33774-1032
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Country | US
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Telephone | 727-586-2674
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Fax | 727-588-0730
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Provider Business Mailing Address
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Address Line | PO BOX 277605
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City | ATLANTA
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State | GA
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Zip | 30384-7605
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Country | US
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Telephone | 727-586-8674
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Fax | 727-588-0730
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARRYL LENTZ
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Credential |
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Telephone | 727-586-8674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | FL
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