MEDICARE: VIERA DIAGNOSTIC CENTER 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	261Q00000X	Clinic/Center	HCC5570	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659347037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIERA DIAGNOSTIC CENTER LLC

Provider Business Mailing Address
First Line	:	7000 SPYGLASS CT
Second Line	:	SUITE 260
City	:	VIERA
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-254-7880
Fax Number	:	321-254-7707

Provider Business Practice Location Address
First Line	:	7000 SPYGLASS CT
Second Line	:	SUITE 260
City	:	VIERA
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-254-7880
Fax Number	:	321-254-7707

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. FRANCIS ABAYOMI OLOMU
Credential	:
Telephone Number	:	321-254-7880

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/22/2008

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Directions to “VIERA DIAGNOSTIC CENTER LLC ” Practice Location

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