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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