Provider Demographics
NPI:1013901883
Name:WEST HERNANDO DIAGNOSTIC & MR CENTER
Entity Type:Organization
Organization Name:WEST HERNANDO DIAGNOSTIC & MR CENTER
Other - Org Name:WEST HERNANDO DIAGNOSTIC CENTER BROOKSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:352-799-0046
Mailing Address - Street 1:15427 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6113
Mailing Address - Country:US
Mailing Address - Phone:352-754-0600
Mailing Address - Fax:352-754-0680
Practice Address - Street 1:15427 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6113
Practice Address - Country:US
Practice Address - Phone:352-754-0600
Practice Address - Fax:352-754-0680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST HERNANDO DIAGNOSTIC & MR CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-07
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272166001Medicaid