Organization
HENDRY DIAGNOSTIC IMAGING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR C BASILE (DIRECTOR)
(863) 983-1103
Entity
Organization
Contact information
Practice address
1008 W SAGAMORE AVE, CLEWISTON, FL 33440-3420
(863) 983-1103
(863) 983-0307
Mailing address
PO BOX 151908, CAPE CORAL, FL 33915-1908
(239) 242-5237
(239) 242-7274
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27010A
BCBS# MEDICAL DIRECTOR
FL
Enumeration date
02/27/2007
Last updated
02/01/2008
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