Provider Demographics
NPI:1134120546
Name:VERO RADIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:VERO RADIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER - CAO AND CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7416
Mailing Address - Street 1:PO BOX 830674
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0674
Mailing Address - Country:US
Mailing Address - Phone:855-666-9508
Mailing Address - Fax:772-621-3184
Practice Address - Street 1:3725 11TH CIRCLE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4804
Practice Address - Country:US
Practice Address - Phone:772-562-0163
Practice Address - Fax:772-567-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2567OtherBLUE CROSS AND BLUE SHIELD
FL014512200Medicaid
FLCB7533OtherRAILROAD MEDICARE
FL97445Medicare PIN