1386731180 NPI number — SPRING HILL IMAGING LLC

Table of content: (NPI 1386731180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386731180 NPI number — SPRING HILL IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRING HILL IMAGING 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:
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:
1386731180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12037 CORTEZ BLVD
Provider Second Line Business Mailing Address:
12037 CORTEZ BLVD
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34613-7349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-597-9008
Provider Business Mailing Address Fax Number:
352-597-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12037 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-597-9008
Provider Business Practice Location Address Fax Number:
352-597-1008
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUTHERFORD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
SENIOR VP
Authorized Official Telephone Number:
615-309-2190

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: P00273445 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V3024 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272083300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008152900 . 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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