Provider Demographics
NPI:1356323331
Name:SMH RADIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:SMH RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:WERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-917-1668
Mailing Address - Street 1:PO BOX 4930
Mailing Address - Street 2:DEPT. 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4930
Mailing Address - Country:US
Mailing Address - Phone:727-793-9300
Mailing Address - Fax:727-793-0052
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-1668
Practice Address - Fax:941-917-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA2230OtherRR MEDICARE
FL33574OtherBC BS OF FLORIDA
FL265094100Medicaid
FL33574Medicare ID - Type Unspecified