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Organization
MAVERICK MEDICAL VENTURES, INC.
Active
Organization
MAVERICK MEDICAL VENTURES, INC.
Active
Other names
Physicians Choice MRI & Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL F BAFIA (PRESIDENT)
(941) 342-7667
Entity
Organization
Contact information
Practice address
3501 CATTLEMEN RD, SUITE C, SARASOTA, FL 34232-6055
(941) 342-7667
(941) 342-7847
Mailing address
3501 CATTLEMEN RD, SUITE C, SARASOTA, FL 34232-6055
(941) 342-7667
(941) 342-7847
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5056
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013853
FIRST HEALTH PROVIDER NUM
FL
01
—
201694
STAYWELL PROVIDER
FL
01
—
226521
AMERIGROUP PROVIDER NUMBE
FL
01
—
5425850
CCN PROVIDER NUMBER
FL
01
—
7180294
AETNA PROVIDER NUMBER
FL
01
—
82030
MEDICARE COMPLETE
FL
01
—
A2545060
OXFORD PROVIDER
FL
01
—
V2973
BCBS PROVIDER NUMBER
FL
Enumeration date
10/25/2006
Last updated
08/22/2020
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