1225114135 NPI number — SUNCOAST DIAGNOSTIC IMAGING INC

Table of content: MR. BRUCE DAVID MILLER RPH (NPI 1861610693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225114135 NPI number — SUNCOAST DIAGNOSTIC IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST DIAGNOSTIC IMAGING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225114135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 BEL AIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33062-7672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-473-1363
Provider Business Mailing Address Fax Number:
954-382-2136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 BEL AIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33062-7672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-473-1363
Provider Business Practice Location Address Fax Number:
954-382-2136
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AZZINARO
Authorized Official First Name:
GUY
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
954-473-1363

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00279207 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 304365 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2851 . This is a "BCBC OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 73526557 . This is a "AENTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2851 . This is a "BLUE CROSS BLUE SHEILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7021200 . This is a "SUNCOAST PHYS HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1168469 . This is a "COVENTRY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1064254 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SG080951 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3540603 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65-689588 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 280289900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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