MEDICARE: PRECISION TELERADIOLOGY 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	261QR0200X	Radiology Clinic/Center		FL
2	261QR0200X	Radiology Clinic/Center	L09000051092	FL

General Provider Information

NPI Number	:	1306194873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION TELERADIOLOGY LLC

Provider Business Mailing Address
First Line	:	8101 GLENFINNAN CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4013
Country	:	US
Telephone Number	:	239-980-4664
Fax Number	:	866-269-2214

Provider Business Practice Location Address
First Line	:	8101 GLENFINNAN CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4013
Country	:	US
Telephone Number	:	239-980-4664
Fax Number	:	866-269-2214

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VICTOR HARLEY GREGORY
Credential	:	D.O.
Telephone Number	:	239-980-4664

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	07/21/2022

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Directions to “PRECISION TELERADIOLOGY LLC ” Practice Location

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