Provider Demographics
NPI:1700850872
Name:TOTAL IMAGING-NORTH ST PETERSBURG LLC
Entity Type:Organization
Organization Name:TOTAL IMAGING-NORTH ST PETERSBURG LLC
Other - Org Name:TOTAL IMAGING-HUDSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-8203
Mailing Address - Street 1:14108 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8595
Mailing Address - Country:US
Mailing Address - Phone:727-861-4490
Mailing Address - Fax:727-869-5480
Practice Address - Street 1:14108 GLACIER DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-861-4490
Practice Address - Fax:727-861-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3084OtherBCBS OF FL
FLAI861AMedicare PIN