Organization
SOUTH BAY HOSPITAL OUTPATIENT DIAGNOSTIC/IMAGING CENTER
Active
Other names
South Bay Imaging LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIS B. NORSOP MD (PRESIDENT)
(813) 899-6220
Entity
Organization
Contact information
Practice address
4051 UPPER CREEK DR, SUN CITY CENTER, FL 33573-6825
(813) 634-8329
Mailing address
PO BOX 22607, TAMPA, FL 33622-2607
(813) 899-6220
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
171863
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171863
LICENSE #
FL
Enumeration date
05/19/2008
Last updated
05/19/2008
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