Provider Demographics
NPI:1093002776
Name:RAD ONE INC
Entity Type:Organization
Organization Name:RAD ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COURSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSRTR
Authorized Official - Phone:941-815-1103
Mailing Address - Street 1:12462 KROME AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-1327
Mailing Address - Country:US
Mailing Address - Phone:941-815-1103
Mailing Address - Fax:239-541-5445
Practice Address - Street 1:12462 KROME AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-1327
Practice Address - Country:US
Practice Address - Phone:941-815-1103
Practice Address - Fax:239-541-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT8522247100000X
FLCRT39038247100000X
FL332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1880149214156OtherRESALE TAX ID
FLP02000132080OtherCORPORATION ID