Organization
ST JOSEPHS DIAGNOSTIC CENTER LLC
Active
Organization
ST JOSEPHS DIAGNOSTIC CENTER LLC
Active
Other names
BayCare Outpatient Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
TAMBLYN CUBERO (MANAGER)
(727) 281-9390
Entity
Organization
Contact information
Practice address
3003 W DR MLK JR BLVD, TAMPA, FL 33607-6307
(813) 870-4826
Mailing address
2995 DREW STREET, EAST BLDG 2ND FLOOR, CLEARWATER, FL 33759
(727) 281-9390
(813) 635-2613
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061048800
—
FL
01
—
V2332
BCBS
FL
01
—
V2333
BCBS
FL
01
—
V2334
BCBS
FL
Enumeration date
11/11/2005
Last updated
01/17/2019
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