1659303733 NPI number — DOCTORS DIAGNOSTIC IMAGING PA

Table of content: (NPI 1659303733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659303733 NPI number — DOCTORS DIAGNOSTIC IMAGING PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS DIAGNOSTIC IMAGING PA
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:
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:
1659303733
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:
2151 JANUARY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-898-4101
Provider Business Mailing Address Fax Number:
314-645-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5731 BEE RIDGE RD
Provider Second Line Business Practice Location Address:
DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34233-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-342-1060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIPMAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-907-9678

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0204X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: APPLYING , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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