Provider Demographics
NPI:1639269392
Name:NORTH BRANDON IMAGING LLC
Entity Type:Organization
Organization Name:NORTH BRANDON IMAGING LLC
Other - Org Name:TOWER DIAGNOSTIC CENTER OF BRANDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-2190
Mailing Address - Street 1:613 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5714
Mailing Address - Country:US
Mailing Address - Phone:813-661-2222
Mailing Address - Fax:813-681-8494
Practice Address - Street 1:613 OAKFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:BRADON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-661-2222
Practice Address - Fax:813-681-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3028OtherBCBS OF FL
FL272079500Medicaid
FLP00280433OtherRR MEDICARE
FLP00280433OtherRR MEDICARE