Provider Demographics
NPI:1225114135
Name:SUNCOAST DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:SUNCOAST DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:AZZINARO
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS RVT RDCS
Authorized Official - Phone:954-473-1363
Mailing Address - Street 1:1821 BEL AIR AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7672
Mailing Address - Country:US
Mailing Address - Phone:954-473-1363
Mailing Address - Fax:954-382-2136
Practice Address - Street 1:1821 BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7672
Practice Address - Country:US
Practice Address - Phone:954-473-1363
Practice Address - Fax:954-382-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00279207OtherRAILROAD MEDICARE
FL304365OtherAVMED
FLV2851OtherBCBC OF FLORIDA
FL73526557OtherAENTA
V2851OtherBLUE CROSS BLUE SHEILD
FL7021200OtherSUNCOAST PHYS HEALTH PLAN
FL1168469OtherCOVENTRY
FL1064254OtherCAREPLUS
FLSG080951OtherVISTA
FL3540603OtherAETNA
FL65-689588OtherTRICARE
FLV2851OtherBCBC OF FLORIDA
FL65-689588OtherTRICARE
FLP00279207OtherRAILROAD MEDICARE
FL=========OtherEVERCARE
FL3540603OtherAETNA
FL73526557OtherAENTA
FL=========OtherPARTNER CARE HEALTH PLANS
FL=========OtherUNITED HEALTHCARE