Provider Demographics
NPI:1649215500
Name:MOLECULAR IMAGING OF BRADENTON LLC
Entity Type:Organization
Organization Name:MOLECULAR IMAGING OF BRADENTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-921-0384
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-921-0384
Mailing Address - Fax:
Practice Address - Street 1:2301 60TH STREET CT W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5509
Practice Address - Country:US
Practice Address - Phone:941-795-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC56912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1334Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID