MEDICARE: STAR RADIOLOGY OF FLORIDA, 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	ME99052	FL

General Provider Information

NPI Number	:	1265894034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR RADIOLOGY OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 320392
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33679-2392
Country	:	US
Telephone Number	:	813-369-7827
Fax Number	:	813-814-1615

Provider Business Practice Location Address
First Line	:	3870 TAMPA RD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3133
Country	:	US
Telephone Number	:	813-369-7827
Fax Number	:	813-814-1615

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DWIGHT A TOWNSEND
Credential	:	MD
Telephone Number	:	361-548-1249

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	01/22/2017

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