Provider Demographics
NPI:1003328642
Name:CLERMONT RADIOLOGY LLC
Entity type:Organization
Organization Name:CLERMONT RADIOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-833-1456
Mailing Address - Street 1:PO BOX 593869
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32859-3869
Mailing Address - Country:US
Mailing Address - Phone:352-241-6100
Mailing Address - Fax:352-241-6101
Practice Address - Street 1:3725 SOUTH HIGHWAY 27
Practice Address - Street 2:SUITE 104
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-241-6100
Practice Address - Fax:352-241-6101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLERMONT RADIOLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology