Provider Demographics
NPI:1851785711
Name:INTERVENTIONAL RADIOLOGY OF SOUTH FLORIDA, LLP
Entity Type:Organization
Organization Name:INTERVENTIONAL RADIOLOGY OF SOUTH FLORIDA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-508-2936
Mailing Address - Street 1:4581 WESTON RD
Mailing Address - Street 2:SUITE 282
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3141
Mailing Address - Country:US
Mailing Address - Phone:954-534-1099
Mailing Address - Fax:
Practice Address - Street 1:1475 W 49TH ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3222
Practice Address - Country:US
Practice Address - Phone:954-534-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty