Basic Information
Provider Information | |||||||||
NPI: | 1417246547 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | INTERVENTIONAL RADIOLOGY ASSOCIATES OF TAMPA LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FLORIDA INTERVENTIONAL SPECIALISTS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2700 UNIVERSITY SQUARE DR | ||||||||
Address2: | FLORIDA INTERVENTIONAL SPECIALISTS (T&C) | ||||||||
City: | TAMPA | ||||||||
State: | FL | ||||||||
PostalCode: | 336125513 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8132515822 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6001 WEBB RD | ||||||||
Address2: | TOWN & COUNTRY HOSPITAL, RADIOLOGY DEPT | ||||||||
City: | TAMPA | ||||||||
State: | FL | ||||||||
PostalCode: | 336153241 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8138887060 | ||||||||
FaxNumber: | 8132532299 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/29/2011 | ||||||||
LastUpdateDate: | 07/19/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LOMBARDI | ||||||||
AuthorizedOfficialFirstName: | MICHAEL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 8132532721 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | HCC6551 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | HCC6551 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.