Provider Demographics
NPI:1821396342
Name:INTERVENTIONAL RADIOLOGY ASSOCIATES OF TAMPA LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL RADIOLOGY ASSOCIATES OF TAMPA LLC
Other - Org Name:FLORIDA INTERVENTIONAL SPECIATLISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-253-2721
Mailing Address - Street 1:2700 UNIVERSITY SQUARE DR
Mailing Address - Street 2:INTERVENTIONAL RADIOLOGY ASSOC OF TAMPA LLC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-253-2721
Mailing Address - Fax:813-253-2299
Practice Address - Street 1:2700 UNIVERSITY SQUARE DR
Practice Address - Street 2:INTERVENTIONAL RADIOLOGY ASSOC OF TAMPA LLC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-253-2721
Practice Address - Fax:813-253-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC65512085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003595700Medicaid
FLFD641AMedicare PIN