Organization
NORTH TAMPA IMAGING LLC
Active
Other names
dba NTIC (New Tampa Imaging Center)
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE HARDIN (CREDENTIALING & ENROLLMENT)
(615) 344-8203
Entity
Organization
Contact information
Practice address
14302 BRUCE B DOWNS BLVD, TAMPA, FL 33613-2601
(813) 975-1111
(813) 975-0555
Mailing address
14302 BRUCE B DOWNS BLVD, TAMPA, FL 33613-2601
(813) 975-1111
(813) 975-0555
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272080900
—
FL
01
—
P00273453
RR MEDICARE
FL
01
—
V3026
BCBS OF FL
FL
Enumeration date
10/26/2006
Last updated
04/17/2009
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