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
—
DN9284
RR MEDICARE
—
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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