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Organization
SOUTH BRANDON IMAGING LLC
Active
Organization
SOUTH BRANDON IMAGING LLC
Active
Other names
Total Imaging Robertson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
737 W BRANDON BLVD, BRANDON, FL 33511-4901
(813) 657-7575
(813) 684-3040
Mailing address
737 W BRANDON BLVD, BRANDON, FL 33511-4901
(813) 657-7575
(813) 684-3040
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00273457
RR MEDICARE
FL
Enumeration date
07/26/2005
Last updated
03/18/2008
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