Provider Demographics
NPI:1316581234
Name:ADVENTHEALTH WEST FLORIDA IMAGING INC
Entity Type:Organization
Organization Name:ADVENTHEALTH WEST FLORIDA IMAGING INC
Other - Org Name:ADVENTHEALTH MOBILE MAMMOGRAPHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CORP RESP OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-803-4022
Mailing Address - Street 1:14055 RIVEREDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2141
Mailing Address - Country:US
Mailing Address - Phone:813-601-1925
Mailing Address - Fax:
Practice Address - Street 1:14055 RIVEREDGE DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-2141
Practice Address - Country:US
Practice Address - Phone:813-601-1925
Practice Address - Fax:813-436-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography