Provider Demographics
NPI:1245319508
Name:SUN CITY CENTER OPEN MRI
Entity type:Organization
Organization Name:SUN CITY CENTER OPEN MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIEGFRIED
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-646-8955
Mailing Address - Street 1:3830 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1105
Mailing Address - Country:US
Mailing Address - Phone:863-646-8955
Mailing Address - Fax:863-648-5216
Practice Address - Street 1:725 CORTARO DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-642-0887
Practice Address - Fax:813-633-6527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIEGFRIED K HOLZ MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257741103Medicaid
FLV2920OtherBLUE CROSS BLUE SHIELD
FL2376442OtherAETNA
FLV2920OtherBLUE CROSS BLUE SHIELD
FL257741103Medicaid
FL=========OtherUNITED HEALTHCARE