Provider Demographics
NPI:1740351477
Name:NORTHSIDE IMAGING LLC
Entity type:Organization
Organization Name:NORTHSIDE IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-344-2274
Mailing Address - Street 1:122 LINSLEY AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-657-4914
Mailing Address - Fax:813-657-4916
Practice Address - Street 1:6006 49TH STREET NORTH
Practice Address - Street 2:SUITE 140
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-528-5900
Practice Address - Fax:727-528-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty