Organization
SUGAR MILL DIAGNOSTIC IMAGING LLC
Active
Organization
SUGAR MILL DIAGNOSTIC IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL KEITH HERRON M.D. (OWNER)
(352) 795-6909
Entity
Organization
Contact information
Practice address
8303 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 628-9900
(352) 628-9700
Mailing address
8303 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 628-9900
(352) 628-9700
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
N/A
FL
261QR0200X
Radiology Clinic/Center
ME84779
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000097000
—
FL
05
—
000097001
—
FL
05
—
002077400
—
FL
01
—
DN9284
RR MEDICARE
FL
01
—
V003E
BLUE CROSS BLUE SHIELD
—
01
—
V3279
BLUE CROSS BLUE SHIELD
—
Enumeration date
12/28/2007
Last updated
07/31/2013
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