Provider Demographics
NPI:1063469690
Name:DIAGNOSTIC OUTPATIENT CENTERS INC
Entity Type:Organization
Organization Name:DIAGNOSTIC OUTPATIENT CENTERS INC
Other - Org Name:DOCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-896-2202
Mailing Address - Street 1:400 12TH AVE N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1120
Mailing Address - Country:US
Mailing Address - Phone:727-896-2202
Mailing Address - Fax:727-822-6407
Practice Address - Street 1:400 12TH AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1120
Practice Address - Country:US
Practice Address - Phone:727-896-2202
Practice Address - Fax:727-822-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1386Medicare ID - Type Unspecified