Provider Demographics
NPI:1982771101
Name:DIAGNOSTIC RADIOLOGY SPECIALISTS
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-781-3888
Mailing Address - Street 1:4133 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3462
Mailing Address - Country:US
Mailing Address - Phone:727-781-3888
Mailing Address - Fax:727-781-3881
Practice Address - Street 1:4133 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3462
Practice Address - Country:US
Practice Address - Phone:727-781-3888
Practice Address - Fax:727-781-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME517292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26649JMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLK4304Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL26649Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLF97075Medicare UPIN