1548378870 NPI number — ADVANTAGE OPEN MRI OF SPRINGHILL

Table of content: (NPI 1548378870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548378870 NPI number — ADVANTAGE OPEN MRI OF SPRINGHILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE OPEN MRI OF SPRINGHILL
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:
PERFORMANCE IMAGING
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:
1548378870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20213
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:
33622-0213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-343-6674
Provider Business Mailing Address Fax Number:
727-343-6675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6705 38TH AVE N
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-343-6674
Provider Business Practice Location Address Fax Number:
727-343-6675
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FELDMAN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
727-343-6674

Provider Taxonomy Codes

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

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





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