Provider Demographics
NPI:1467448639
Name:SUNCOAST IMAGING PARTNERS
Entity Type:Organization
Organization Name:SUNCOAST IMAGING PARTNERS
Other - Org Name:COMMUNITY DIAGNOSTIC OF BRANDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-496-1075
Mailing Address - Street 1:4519 GEORGE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7329
Mailing Address - Country:US
Mailing Address - Phone:813-496-1075
Mailing Address - Fax:
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:STE 111
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-496-1075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME738192085R0202X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4356Medicare PIN
FLDA4649Medicare PIN