1376618918 NPI number — SUNCOAST MEDICAL IMAGING ASSOCIATES

Table of content: KRISTIN LYNN NEIL LPC (NPI 1659127520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376618918 NPI number — SUNCOAST MEDICAL IMAGING ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST MEDICAL IMAGING ASSOCIATES
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:
6
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:
1376618918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1391
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33779-1391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-446-5150
Provider Business Mailing Address Fax Number:
727-446-6889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 INDIAN ROCKS RD S
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-446-5150
Provider Business Practice Location Address Fax Number:
727-446-6889
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUDELKO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF RADIOLOGIST
Authorized Official Telephone Number:
727-446-5150

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 99746 . This is a "GROUP PIN NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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