Provider Demographics
NPI:1245677327
Name:PENSACOLA IMAGING, LLC
Entity type:Organization
Organization Name:PENSACOLA IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-776-3111
Mailing Address - Street 1:12385 SORRENTO ROAD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8656
Mailing Address - Country:US
Mailing Address - Phone:850-492-7647
Mailing Address - Fax:850-492-7583
Practice Address - Street 1:12385 SORRENTO ROAD
Practice Address - Street 2:SUITE B1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507
Practice Address - Country:US
Practice Address - Phone:850-492-7647
Practice Address - Fax:850-492-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN96022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty