Provider Demographics
NPI:1093981490
Name:SOUTH BAY HOSPITAL OUTPATIENT DIAG/IMAGING CTR
Entity Type:Organization
Organization Name:SOUTH BAY HOSPITAL OUTPATIENT DIAG/IMAGING CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF RADIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NORSOPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-899-6226
Mailing Address - Street 1:6983 E. FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-899-6226
Mailing Address - Fax:
Practice Address - Street 1:4051 UPPER CREEK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6825
Practice Address - Country:US
Practice Address - Phone:813-899-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty