Provider Demographics
NPI:1265481451
Name:RADIOLOGY CONSULTANTS IMAGING CENTER LLC
Entity Type:Organization
Organization Name:RADIOLOGY CONSULTANTS IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-292-0297
Mailing Address - Street 1:400 AVENUE K SE
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4146
Mailing Address - Country:US
Mailing Address - Phone:863-292-0297
Mailing Address - Fax:863-292-0327
Practice Address - Street 1:400 AVENUE K SE
Practice Address - Street 2:BUILDING 4
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4146
Practice Address - Country:US
Practice Address - Phone:863-292-0297
Practice Address - Fax:863-292-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR4036000261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3944Medicare ID - Type Unspecified