Organization
NORTH BRANDON IMAGING LLC
Active
Other names
Tower Diagnostic Center of Brandon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
613 OAKFIELD DR, BRANDON, FL 33511-5714
(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
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272079500
—
FL
01
—
P00280433
RR MEDICARE
FL
01
—
V3028
BCBS OF FL
FL
Enumeration date
06/21/2005
Last updated
10/09/2008
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