Organization
CARROLLWOOD DIAGNOSTIC IMAGING
Active
Other names
Premier Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLIS B. NORSOPH M.D. (PRESIDENT)
(813) 899-6220
Entity
Organization
Contact information
Practice address
7171 N DALE MABRY HWY, TAMPA, FL 33614-2630
(813) 932-2222
(813) 985-8006
Mailing address
PO BOX 47269, TAMPA, FL 33647-0111
(813) 899-6220
(813) 985-8006
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
114748 0000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2765
BCBS OF FLORIDA
FL
Enumeration date
05/18/2006
Last updated
08/22/2020
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