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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