Provider Demographics
NPI: | 1902261241 |
---|---|
Name: | PORT CHARLOTTE RADIOLOGY CONSULTANTS PA |
Entity Type: | Organization |
Organization Name: | PORT CHARLOTTE RADIOLOGY CONSULTANTS PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELLIS |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | NORSOPH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 813-899-6220 |
Mailing Address - Street 1: | 100 S ASHLEY DR |
Mailing Address - Street 2: | SUITE 1500 |
Mailing Address - City: | TAMPA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33602-5304 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-899-6220 |
Mailing Address - Fax: | 813-985-8006 |
Practice Address - Street 1: | 2500 HARBOR BLVD |
Practice Address - Street 2: | |
Practice Address - City: | PORT CHARLOTTE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33952-5000 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-766-4140 |
Practice Address - Fax: | 813-985-8006 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-12-30 |
Last Update Date: | 2015-12-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Single Specialty |