Provider Demographics
NPI:1285690099
Name:ORMOND RADIOLOGY PARTNERSHIP, L.L.C.
Entity Type:Organization
Organization Name:ORMOND RADIOLOGY PARTNERSHIP, L.L.C.
Other - Org Name:SUNCOAST MRI OF ORMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN RESOURCES/CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:JT
Authorized Official - Middle Name:
Authorized Official - Last Name:TENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-8070
Mailing Address - Street 1:500 MEMORIAL CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5054
Mailing Address - Country:US
Mailing Address - Phone:386-673-8040
Mailing Address - Fax:386-267-0693
Practice Address - Street 1:500 MEMORIAL CIR
Practice Address - Street 2:SUITE E-2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5054
Practice Address - Country:US
Practice Address - Phone:386-673-7056
Practice Address - Fax:386-673-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3002OtherBCBS GROUP NUMBER
FLCD5225OtherRR MEDICARE GROUP #
FLV3002OtherBCBS GROUP NUMBER