Provider Demographics
NPI:1437153202
Name:S.M.S. IMAGING
Entity Type:Organization
Organization Name:S.M.S. IMAGING
Other - Org Name:FLORIDA INSTITUTE FOR ADVANCED DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITIES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LHRM, CCS-P
Authorized Official - Phone:727-868-2151
Mailing Address - Street 1:11528 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1442
Mailing Address - Country:US
Mailing Address - Phone:727-868-2151
Mailing Address - Fax:727-868-8251
Practice Address - Street 1:9238 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4853
Practice Address - Country:US
Practice Address - Phone:727-849-8491
Practice Address - Fax:727-849-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 3869207Q00000X
247100000X, 2471B0102X, 2471C3401X, 2471M1202X, 2471N0900X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10851101OtherCITRUS
FL271506600Medicaid
FL297482OtherAVMED
FLE6730OtherBLUE CROSS BLUE SHIELD FLORIDA
FLP00074180OtherRAILROAD MEDICARE
FL01590OtherUNIVERSAL HEALTH CARE
FLE6730Medicare PIN