Provider Demographics
NPI:1346443819
Name:SARA RADIOLOGY INC
Entity Type:Organization
Organization Name:SARA RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-0677
Mailing Address - Street 1:7595 BAYMEADOWS CIR W
Mailing Address - Street 2:APT#506
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1879
Mailing Address - Country:US
Mailing Address - Phone:301-404-9552
Mailing Address - Fax:
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:UNIT #7
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-625-0677
Practice Address - Fax:941-625-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95607261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology