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Organization
ULTRA IMAGING OF TAMPA LLC
Active
Organization
ULTRA IMAGING OF TAMPA LLC
Active
Other names
Ultra Imaging of Lakeland
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE R HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
2946 LAKELAND HIGHLANDS RD, HIGHLANDS PLAZA, LAKELAND, FL 33803-4379
(863) 583-1674
(863) 583-1678
Mailing address
2946 LAKELAND HIGHLANDS RD, HIGHLANDS PLAZA, LAKELAND, FL 33803-4379
(863) 583-1674
(863) 583-1678
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Enumeration date
07/07/2005
Last updated
08/02/2007
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