Provider Demographics
NPI:1750388591
Name:ULTRA IMAGING OF TAMPA, LLC
Entity type:Organization
Organization Name:ULTRA IMAGING OF TAMPA, 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 1:36452 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1330
Mailing Address - Country:US
Mailing Address - Phone:727-771-2674
Mailing Address - Fax:727-781-6376
Practice Address - Street 1:36452 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1330
Practice Address - Country:US
Practice Address - Phone:727-771-2674
Practice Address - Fax:727-781-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)