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General NPI Number Information
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NPI Number | 1922085208
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Entity Type | Organization
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Legal Business Name | SAPPHIRE BRANDON LTD
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 615 VONDERBURG DR
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City | BRANDON
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State | FL
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Zip | 33511-5972
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Country | US
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Telephone | 813-657-5579
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Fax | 813-675-6130
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Provider Business Mailing Address
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Address Line | 615 VONDERBURG DR
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City | BRANDON
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State | FL
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Zip | 33511-5972
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Country | US
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Telephone | 813-205-0312
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Fax | 813-657-6130
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | JEFFREY STONE
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Credential |
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Telephone | 813-205-0312
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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 | HCC4890
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License Number State | FL
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