Provider Demographics
NPI:1366638934
Name:US IMAGING CENTER CORP LLC
Entity Type:Organization
Organization Name:US IMAGING CENTER CORP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-441-0060
Mailing Address - Street 1:842 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE301
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7551
Mailing Address - Country:US
Mailing Address - Phone:941-441-0060
Mailing Address - Fax:
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE301
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-441-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5096Medicare PIN