Provider Demographics
NPI:1346584075
Name:ITF MOBILE BX, LLC
Entity Type:Organization
Organization Name:ITF MOBILE BX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-505-3098
Mailing Address - Street 1:4128 CAUSEWAY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5416
Mailing Address - Country:US
Mailing Address - Phone:727-505-3098
Mailing Address - Fax:813-882-3679
Practice Address - Street 1:4128 CAUSEWAY VISTA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5416
Practice Address - Country:US
Practice Address - Phone:727-505-3098
Practice Address - Fax:813-882-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 63242261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile