Provider Demographics
NPI:1629162904
Name:ROSE RADIOLOGY CENTERS, LLC
Entity Type:Organization
Organization Name:ROSE RADIOLOGY CENTERS, LLC
Other - Org Name:AKUMIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-300-2777
Mailing Address - Street 1:8300 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5406
Mailing Address - Country:US
Mailing Address - Phone:727-781-3888
Mailing Address - Fax:727-784-0616
Practice Address - Street 1:4133 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3462
Practice Address - Country:US
Practice Address - Phone:727-781-3888
Practice Address - Fax:727-784-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51729174400000X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2668OtherBCBS PROVIDER NUMBER
FLV3015OtherBCBS PROVIDER NUMBER
FLV2669OtherBCBS PROVIDER NUMBER
FLV2667OtherBCBS PROVIDER NUMBER
FLV3119OtherBCBS PROVIDER NUMBER
FLV2669OtherBCBS PROVIDER NUMBER
FLE6776Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FLE6774BMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FLE6774AMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FLV2668OtherBCBS PROVIDER NUMBER