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General NPI Number Information
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NPI Number | 1912931924
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Entity Type | Organization
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Legal Business Name | TWO RIVERS DIAGNOSTIC CENTER INC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 2810 MANATEE AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1828
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Country | US
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Telephone | 941-827-0051
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Fax | 941-827-0057
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Provider Business Mailing Address
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Address Line | 2810 MANATEE AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1828
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Country | US
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Telephone | 941-827-0051
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Fax | 941-827-0057
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. BARBARA SIMON
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Credential |
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Telephone | 941-827-0051
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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 | HCC6008
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License Number State | FL
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