1093823320 NPI number — ADVANTAGE OPEN MRI OF SPRING HILL

Table of content: (NPI 1093823320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093823320 NPI number — ADVANTAGE OPEN MRI OF SPRING HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE OPEN MRI OF SPRING HILL
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:
1093823320
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:
1200 S PINELLAS AVE #14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARPON SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-939-2674
Provider Business Mailing Address Fax Number:
727-939-2000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 D STREET #B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-461-6674
Provider Business Practice Location Address Fax Number:
727-461-6675
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
GARY
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
727-939-2674

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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