MEDICARE: ITF MOBILE BX, 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	261QR0208X	Mobile Radiology Clinic/Center	ME 63242	FL

General Provider Information

NPI Number	:	1346584075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITF MOBILE BX, LLC

Provider Business Mailing Address
First Line	:	4128 CAUSEWAY VISTA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-5416
Country	:	US
Telephone Number	:	727-505-3098
Fax Number	:	813-882-3679

Provider Business Practice Location Address
First Line	:	4128 CAUSEWAY VISTA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-5416
Country	:	US
Telephone Number	:	727-505-3098
Fax Number	:	813-882-3679

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENIS WILLIAM STEWART
Credential	:	M.D.
Telephone Number	:	727-505-3098

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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