Organization
BAYCARE OUTPATIENT IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA GORKEN (VICE PRESIDENT)
(727) 281-9202
Entity
Organization
Contact information
Practice address
3198 N. PARK ROAD, SUITE 102, PLANT CITY, FL 33563
(813) 757-1204
(813) 757-1212
Mailing address
2995 DREW ST FL 2, CLEARWATER, FL 33759-3012
(727) 315-6974
(813) 635-2613
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101818505
—
FL
Enumeration date
04/11/2023
Last updated
07/11/2024
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