Provider Demographics
NPI:1134459720
Name:RADIANCE RADIOLOGY INC
Entity Type:Organization
Organization Name:RADIANCE RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMAKHA
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:727-815-2423
Mailing Address - Street 1:37566 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1019
Mailing Address - Country:US
Mailing Address - Phone:727-815-2423
Mailing Address - Fax:727-330-7760
Practice Address - Street 1:37566 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1019
Practice Address - Country:US
Practice Address - Phone:727-815-2423
Practice Address - Fax:727-330-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT73617332B00000X, 332BX2000X
335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies