Organization
NORTH BRANDON IMAGING LLC
Active
Organization
NORTH BRANDON IMAGING LLC
Active
Other names
Tower Diagnostic Center of Brandon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM B. RUTHERFORD (SENIOR VP)
(615) 309-2190
Entity
Organization
Contact information
Practice address
613 OAKFIELD DRIVE, BRADON, FL 33511
(813) 661-2222
(813) 681-8494
Mailing address
613 OAKFIELD DR, BRANDON, FL 33511-5714
(813) 661-2222
(813) 681-8494
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272079500
—
FL
01
—
P00280433
RR MEDICARE
FL
01
—
V3028
BCBS OF FL
FL
Enumeration date
10/13/2006
Last updated
08/30/2011
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