Basic Information
| Provider Information | |||||||||
| NPI: | 1437153202 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | S.M.S. IMAGING | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FLORIDA INSTITUTE FOR ADVANCED DIAGNOSTIC IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11528 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346681442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278682151 | ||||||||
| FaxNumber: | 7278688251 | ||||||||
| Practice Location | |||||||||
| Address1: | 9238 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346684853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278498491 | ||||||||
| FaxNumber: | 7278493472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRIENZA | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | FACILITIES DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7278682151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, LHRM, CCS-P | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS 3869 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 2471B0102X | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Bone Densitometry | 2471C3401X | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | 2471M1202X | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging | 2471N0900X | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Nuclear Medicine Technology | 2471S1302X | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography | 247100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
ID Information
| ID | Type | State | Issuer | Description | 10851101 | 01 | FL | CITRUS | OTHER | 271506600 | 05 | FL | MEDICAID | 297482 | 01 | FL | AVMED | OTHER | E6730 | 01 | FL | BLUE CROSS BLUE SHIELD FLORIDA | OTHER | P00074180 | 01 | FL | RAILROAD MEDICARE | OTHER | 01590 | 01 | FL | UNIVERSAL HEALTH CARE | OTHER |