Provider Demographics
NPI:1588023261
Name:FLORIDA GULFCOAST MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:FLORIDA GULFCOAST MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKEENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-549-5310
Mailing Address - Street 1:9822 TREE TOPS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4764
Mailing Address - Country:US
Mailing Address - Phone:304-549-5310
Mailing Address - Fax:606-644-0444
Practice Address - Street 1:9822 TREE TOPS LAKE RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4764
Practice Address - Country:US
Practice Address - Phone:304-549-5310
Practice Address - Fax:606-644-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME648152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty