Provider Demographics
NPI:1376710327
Name:PRICE HOFFMAN STONE & ASSOCIATES MDS PA
Entity Type:Organization
Organization Name:PRICE HOFFMAN STONE & ASSOCIATES MDS PA
Other - Org Name:DIAGNOSTIC IMAGING AT BAYWALK
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-898-3647
Mailing Address - Street 1:DEPT AT 952404
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31192-0001
Mailing Address - Country:US
Mailing Address - Phone:727-896-2273
Mailing Address - Fax:727-895-2554
Practice Address - Street 1:129 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3301
Practice Address - Country:US
Practice Address - Phone:727-896-2273
Practice Address - Fax:727-895-2554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRICE HOFFMAN STONE & ASSOCIATES MDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC1932261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044931801Medicaid
FLV2871OtherBCBS OF FL
FL00022Medicare PIN