MEDICARE: TAMPA BAY MRI 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	ME79221	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1902146822	OTHER	FL	PRIVATE INSURANCE, PERSONAL INJURY PROTECTION, CASH

General Provider Information

NPI Number	:	1316363948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY MRI LLC

Provider Business Mailing Address
First Line	:	1931 W. MARTIN LUTHER KING BLVD
Second Line	:	SUITE F
City	:	TAMPA
State	:	FL
Zip	:	33607-0000
Country	:	US
Telephone Number	:	813-872-0931
Fax Number	:	813-872-0022

Provider Business Practice Location Address
First Line	:	1931 W. MARTIN LUTHER KING BLVD
Second Line	:	SUITE F
City	:	TAMPA
State	:	FL
Zip	:	33607-0000
Country	:	US
Telephone Number	:	813-872-0931
Fax Number	:	813-872-0022

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VICTOR AUGUSTO SILVA
Credential	:	M.D.
Telephone Number	:	813-872-0931

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	03/24/2016

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