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General NPI Number Information
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NPI Number | 1912051228
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Entity Type | Organization
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Legal Business Name | OAKRIDGE MEDICAL GROUP
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 NE 56TH ST ATTN BUSINESS OFFICE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-4149
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Country | US
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Telephone | 954-958-0606
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Fax | 954-776-0821
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Provider Business Mailing Address
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Address Line | 1000 NE 56TH ST ATTN BUSINESS OFFICE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-4149
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Country | US
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Telephone | 954-958-0606
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Fax | 954-776-0821
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MR. FRITZ PHANORD
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Credential |
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Telephone | 954-958-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | JR3583900
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License Number State | FL
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