Basic Information
| Provider Information | |||||||||
| NPI: | 1457724379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA NUCLEAR GROUP, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14889 INDIGO LAKES DR | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341194802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017236224 | ||||||||
| FaxNumber: | 2397321145 | ||||||||
| Practice Location | |||||||||
| Address1: | 14889 INDIGO LAKES DR | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341194802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017236224 | ||||||||
| FaxNumber: | 2397321145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2015 | ||||||||
| LastUpdateDate: | 11/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2017236224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.