1346481678 NPI number — SHERIDAN RADIOLOGY SERVICES OF CENTRAL FLORIDA INC

Table of content: (NPI 1346481678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346481678 NPI number — SHERIDAN RADIOLOGY SERVICES OF CENTRAL FLORIDA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERIDAN RADIOLOGY SERVICES OF CENTRAL FLORIDA 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:
1346481678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 452047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33345-2047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:
954-851-1758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1619 HARRISON PKWY
Provider Second Line Business Practice Location Address:
BLDG D
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33323-2856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-742-7927
Provider Business Practice Location Address Fax Number:
954-851-1758
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DROZDOW
Authorized Official First Name:
GILBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-838-2371

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: 000173727 . 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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