1629162904 NPI number — ROSE RADIOLOGY CENTERS, LLC

Table of content: (NPI 1629162904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629162904 NPI number — ROSE RADIOLOGY CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSE RADIOLOGY CENTERS, 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:
1629162904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 W SUNRISE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33322-5406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-781-3888
Provider Business Mailing Address Fax Number:
727-784-0616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4133 WOODLANDS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34685-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-781-3888
Provider Business Practice Location Address Fax Number:
727-784-0616
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASSA
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
904-300-2777

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME51729 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: ME51729 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: V2668 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V3015 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2669 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2667 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V3119 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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