Basic Information
| Provider Information | |||||||||
| NPI: | 1265894034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STAR RADIOLOGY OF FLORIDA, LLC | ||||||||
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| OtherOrganizationName: | RADIOLOGY AND DIAGNOSTIC IMAGING OF FLORIDA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 320392 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336792392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133697827 | ||||||||
| FaxNumber: | 8138141615 | ||||||||
| Practice Location | |||||||||
| Address1: | 3870 TAMPA RD | ||||||||
| Address2: | |||||||||
| City: | OLDSMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346773133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133697827 | ||||||||
| FaxNumber: | 8138141615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 01/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | TOWNSEND | ||||||||
| AuthorizedOfficialFirstName: | DWIGHT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3615481249 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME99052 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.