Provider Demographics
NPI:1326021346
Name:UNIVERSITY DIAGNOSTIC INSTITUTE LTD
Entity Type:Organization
Organization Name:UNIVERSITY DIAGNOSTIC INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-972-3351
Mailing Address - Street 1:3301 ALUMNI DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9413
Mailing Address - Country:US
Mailing Address - Phone:813-972-3351
Mailing Address - Fax:913-971-6892
Practice Address - Street 1:3301 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9413
Practice Address - Country:US
Practice Address - Phone:813-972-3351
Practice Address - Fax:913-971-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06060900Medicaid
FL227379OtherAMERIGROUP
FLV2338OtherBLUE CROSS BLUE SHIELD
FL081944OtherAVMED
FL06060900Medicaid