Basic Information
| Provider Information | |||||||||
| NPI: | 1134120546 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERO RADIOLOGY ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 830674 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352830674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556669508 | ||||||||
| FaxNumber: | 7726213184 | ||||||||
| Practice Location | |||||||||
| Address1: | 3725 11TH CIRCLE | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329604804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725620163 | ||||||||
| FaxNumber: | 7725675631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | GARDNER | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7725674311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CB7533 | 01 | FL | RAILROAD MEDICARE | OTHER | 014512200 | 05 | FL | MEDICAID | V2567 | 01 | FL | BLUE CROSS AND BLUE SHIELD | OTHER |