Provider Demographics
NPI:1437147311
Name:HARBOR CITY MEDICAL IMAGING PA
Entity Type:Organization
Organization Name:HARBOR CITY MEDICAL IMAGING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-722-0423
Mailing Address - Street 1:1920 S BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4445
Mailing Address - Country:US
Mailing Address - Phone:321-722-0423
Mailing Address - Fax:866-747-3794
Practice Address - Street 1:1920 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4445
Practice Address - Country:US
Practice Address - Phone:321-722-0423
Practice Address - Fax:866-747-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266996001Medicaid
FL266996002Medicaid
FLDA0119OtherGROUP RR MEDICARE
FL34784OtherBCBS
FL266996000Medicaid
FL266996002Medicaid