Provider Demographics
NPI:1801889902
Name:MRI-SOUTH UMBERTON INC
Entity type:Organization
Organization Name:MRI-SOUTH UMBERTON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-4617
Mailing Address - Street 1:551 N CATTLEMEN RD
Mailing Address - Street 2:202
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6444
Mailing Address - Country:US
Mailing Address - Phone:941-926-6228
Mailing Address - Fax:941-371-6719
Practice Address - Street 1:6500 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5030
Practice Address - Country:US
Practice Address - Phone:727-548-6736
Practice Address - Fax:727-548-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC36882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061303701Medicaid
FL061303701Medicaid