Provider Demographics
NPI:1598201998
Name:PRIME RADIOLOGY OF PINE HILLS, INC
Entity Type:Organization
Organization Name:PRIME RADIOLOGY OF PINE HILLS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-597-0251
Mailing Address - Street 1:828 MERCY DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808
Mailing Address - Country:US
Mailing Address - Phone:407-597-0251
Mailing Address - Fax:407-745-1239
Practice Address - Street 1:828 MERCY DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808
Practice Address - Country:US
Practice Address - Phone:407-597-0251
Practice Address - Fax:407-745-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty