Basic Information
| Provider Information | |||||||||
| NPI: | 1538524871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORT CHARLOTTE RADIOLOGY CONSULTANTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S ASHLEY DR | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138996220 | ||||||||
| FaxNumber: | 8139858006 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 E MARION AVE | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416393131 | ||||||||
| FaxNumber: | 9416372579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | NORSOPH | ||||||||
| AuthorizedOfficialFirstName: | ELLIS | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8138996220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.