Provider Demographics
NPI:1851930671
Name:RADIANCE RADIOLOGY INC
Entity Type:Organization
Organization Name:RADIANCE RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMAKHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-723-9729
Mailing Address - Street 1:37566 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1019
Mailing Address - Country:US
Mailing Address - Phone:727-934-5500
Mailing Address - Fax:727-934-5507
Practice Address - Street 1:37566 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1019
Practice Address - Country:US
Practice Address - Phone:727-934-5500
Practice Address - Fax:727-934-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty