Provider Demographics
NPI:1629218573
Name:TOWER IMAGING LLC
Entity Type:Organization
Organization Name:TOWER IMAGING LLC
Other - Org Name:TGH IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-261-2400
Mailing Address - Street 1:2700 UNIVERSITY SQUARE DR
Mailing Address - Street 2:TOWER RADIOLOGY CENTER - N DALE MABRY
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:
Practice Address - Street 1:17503 DALE MABRY HWY N
Practice Address - Street 2:TOWER RADIOLOGY CENTER - N DALE MABRY
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4521
Practice Address - Country:US
Practice Address - Phone:813-968-4540
Practice Address - Fax:813-968-4502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWER IMAGING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-04
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085P0229X, 2085R0202X
FLHCC7359261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271846404Medicaid
FL00169Medicare PIN
FL271846404Medicaid