MEDICARE: NORTH BRANDON IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1023009842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BRANDON IMAGING, LLC

Provider Business Mailing Address
First Line	:	613 OAKFIELD DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5714
Country	:	US
Telephone Number	:	813-661-2222
Fax Number	:	813-681-8494

Provider Business Practice Location Address
First Line	:	613 OAKFIELD DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5714
Country	:	US
Telephone Number	:	813-661-2222
Fax Number	:	813-681-8494

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. PATRICK BIRMINGHAM
Credential	:
Telephone Number	:	615-373-7625

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/22/2020

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