Provider Demographics
NPI:1104198258
Name:BOWES IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:BOWES IMAGING CENTER, LLC
Other - Org Name:AXCESS DIAGNOSTICS POINTE WEST
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-924-8600
Mailing Address - Street 1:3900 CLARK RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2301
Mailing Address - Country:US
Mailing Address - Phone:941-924-4860
Mailing Address - Fax:941-924-2300
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:SUITE P
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-924-8600
Practice Address - Fax:941-924-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 95482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC9548OtherSTATE LICENSE
FLU3609AMedicare PIN