Provider Demographics
NPI:1922085208
Name:SAPPHIRE BRANDON LTD
Entity Type:Organization
Organization Name:SAPPHIRE BRANDON LTD
Other - Org Name:BRANDON OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-205-0312
Mailing Address - Street 1:615 VONDERBURG DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5972
Mailing Address - Country:US
Mailing Address - Phone:813-205-0312
Mailing Address - Fax:813-657-6130
Practice Address - Street 1:615 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5972
Practice Address - Country:US
Practice Address - Phone:813-657-5579
Practice Address - Fax:813-675-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4890261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030708400Medicaid
FLE6450Medicare ID - Type Unspecified