Provider Demographics
NPI:1790718096
Name:TAMPA BAY IMAGING LLC
Entity Type:Organization
Organization Name:TAMPA BAY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-386-3674
Mailing Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6386
Mailing Address - Country:US
Mailing Address - Phone:813-386-3674
Mailing Address - Fax:813-386-0499
Practice Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6386
Practice Address - Country:US
Practice Address - Phone:813-386-3674
Practice Address - Fax:813-386-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5727261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL241688OtherAMERIGROUP
FL2674773001OtherCIGNA
FLP00062673OtherUHC
FLV2942OtherBCBS
FL0007411287OtherAETNA
FL195641OtherWELLCARE/STAYWELL
FL195641OtherWELLCARE/STAYWELL
FL241688OtherAMERIGROUP
FL=========OtherHUMANA
FL=========OtherAMERICHOICE