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Organization
NORTH BRANDON IMAGING LLC
Active
Organization
NORTH BRANDON IMAGING LLC
Active
Other names
Tower Diagnostic Center of Brandon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
613 OAKFIELD DR, BRANDON, FL 33511-5714
(813) 661-2222
(813) 681-8494
Mailing address
613 OAKFIELD DR, BRANDON, FL 33511-5714
(813) 661-2222
(813) 681-8494
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
05
—
272079500
—
FL
01
—
P00280433
RR MEDICARE
FL
01
—
V3028
BCBS OF FL
FL
Enumeration date
06/21/2005
Last updated
10/09/2008
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