Provider Demographics
NPI:1003104019
Name:PROSTATE IMAGING LLC
Entity Type:Organization
Organization Name:PROSTATE IMAGING LLC
Other - Org Name:ATLANTIC HIFU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-249-0490
Mailing Address - Street 1:3665 BEE RIDGE RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3665 BEE RIDGE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1054
Practice Address - Country:US
Practice Address - Phone:205-249-0490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty