Organization
SOUTH BRANDON IMAGING LLC
Active
Organization
SOUTH BRANDON IMAGING LLC
Active
Other names
Total Imaging of Robertson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE HARDIN (ENROLLMENT)
(615) 344-8203
Entity
Organization
Contact information
Practice address
737 W BRANDON BLVD, BRANDON, FL 33511-4901
(813) 657-7575
(813) 684-3040
Mailing address
737 W BRANDON BLVD, BRANDON, FL 33511-4901
(813) 657-7575
(813) 684-3040
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00273457
RR MEDICARE
FL
Enumeration date
10/26/2006
Last updated
03/18/2008
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