Provider Demographics
NPI:1578018305
Name:MRI ASSOCIATES OF BRANDON, LLC
Entity Type:Organization
Organization Name:MRI ASSOCIATES OF BRANDON, LLC
Other - Org Name:BRANDON MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-787-6900
Mailing Address - Street 1:403 S KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5905
Mailing Address - Country:US
Mailing Address - Phone:813-210-8995
Mailing Address - Fax:813-409-2914
Practice Address - Street 1:403 S KINGS AVE STE 200R
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5905
Practice Address - Country:US
Practice Address - Phone:813-210-8995
Practice Address - Fax:813-409-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
FLHCC10828261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW07MOtherBCBS
FL019700100Medicaid