Provider Demographics
NPI:1982040119
Name:UNIVERSAL RADIOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:UNIVERSAL RADIOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:AROV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:414-807-4972
Mailing Address - Street 1:PO BOX 25428
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277
Mailing Address - Country:US
Mailing Address - Phone:941-364-9028
Mailing Address - Fax:
Practice Address - Street 1:900 N ROBERT AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8712
Practice Address - Country:US
Practice Address - Phone:863-494-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS116782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006708300Medicaid