Provider Demographics
NPI:1265894034
Name:STAR RADIOLOGY OF FLORIDA, LLC
Entity type:Organization
Organization Name:STAR RADIOLOGY OF FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-548-1249
Mailing Address - Street 1:PO BOX 320392
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2392
Mailing Address - Country:US
Mailing Address - Phone:813-369-7827
Mailing Address - Fax:813-814-1615
Practice Address - Street 1:3870 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3133
Practice Address - Country:US
Practice Address - Phone:813-369-7827
Practice Address - Fax:813-814-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME990522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIS320AMedicare PIN
FL001743000Medicaid
FL86988RMedicare Oscar/Certification