Provider Demographics
NPI:1437102332
Name:IMAGING CENTER OF PENSACOLA INC
Entity Type:Organization
Organization Name:IMAGING CENTER OF PENSACOLA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-475-9040
Mailing Address - Street 1:4996 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2344
Mailing Address - Country:US
Mailing Address - Phone:850-475-9040
Mailing Address - Fax:850-475-9049
Practice Address - Street 1:4996 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2344
Practice Address - Country:US
Practice Address - Phone:850-475-9040
Practice Address - Fax:850-475-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA21371Medicare ID - Type UnspecifiedPROVIDER NUMBER