Provider Demographics
NPI:1073353462
Name:ICARE360 IMAGING LLC
Entity type:Organization
Organization Name:ICARE360 IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAXWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-692-7947
Mailing Address - Street 1:17812 SAINT LUCIA ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2714
Mailing Address - Country:US
Mailing Address - Phone:813-692-7947
Mailing Address - Fax:813-692-7937
Practice Address - Street 1:7323 GREEN SLOPE DR STE 101
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1311
Practice Address - Country:US
Practice Address - Phone:813-692-7947
Practice Address - Fax:813-692-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty