1134120546 NPI number — VERO RADIOLOGY ASSOCIATES LLC

Table of content: (NPI 1134120546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134120546 NPI number — VERO RADIOLOGY ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERO RADIOLOGY ASSOCIATES LLC
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:
1134120546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 830674
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35283-0674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-666-9508
Provider Business Mailing Address Fax Number:
772-621-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3725 11TH CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-562-0163
Provider Business Practice Location Address Fax Number:
772-567-5631
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LONGVILLE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OFFICER - CAO AND CONTROLLER
Authorized Official Telephone Number:
216-636-7416

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: V2567 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014512200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB7533 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014512200 . 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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