Provider Demographics
NPI:1215011994
Name:PRECISE DIAGNOSTIC IMAGING OF BRANDON
Entity Type:Organization
Organization Name:PRECISE DIAGNOSTIC IMAGING OF BRANDON
Other - Org Name:SIEGFRIED K HOLZ MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIEGFRIED
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DM
Authorized Official - Phone:863-646-8955
Mailing Address - Street 1:1111 OAKFIELD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4948
Mailing Address - Country:US
Mailing Address - Phone:863-661-5866
Mailing Address - Fax:
Practice Address - Street 1:1111 OAKFIELD DR STE 103
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4948
Practice Address - Country:US
Practice Address - Phone:863-661-5866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2921OtherBC/BS
FL2376427OtherAETNA
FLV2921OtherBC/BS
FLD55079Medicare UPIN
FL=========OtherUNITED HEALTHCARE