1528059953 NPI number — ULTRA IMAGING OF TAMPA, LLC

Table of content: (NPI 1528059953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528059953 NPI number — ULTRA IMAGING OF TAMPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ULTRA IMAGING OF TAMPA, 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:
DBA ULTRA IMAGING OF TAMPA
Provider Other Organization Name Type Code:
3
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:
1528059953
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:
2137 W. MARTIN LUTHER KING JR. BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-879-1674
Provider Business Mailing Address Fax Number:
813-876-6471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2137 W. MARTIN LUTHER KING JR. BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-879-1674
Provider Business Practice Location Address Fax Number:
813-876-6471
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HANKINS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
SAMUEL
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
615-373-7625

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)