Organization
ORMOND RADIOLOGY PARTNERSHIP, L.L.C
Active
Organization
ORMOND RADIOLOGY PARTNERSHIP, L.L.C
Active
Other names
Suncoast Imaging of Port Orange
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JT TENER (HUMAN RESOURCES/CREDENTIALING)
(386) 673-8040
Entity
Organization
Contact information
Practice address
1680 DUNLAWTON AVE, PORT ORANGE, FL 32127-4754
(386) 304-1212
(386) 304-4432
Mailing address
500 MEMORIAL CIR, SUITE B, OMROND BEACH, FL 32174-5054
(386) 673-8040
(386) 267-0693
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG5244
RR MEDICARE GROUP #
FL
01
—
V3001
BCBS GROUP NUMBER
FL
Enumeration date
04/21/2006
Last updated
12/12/2007
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