NPIMap

Organization Active NPI

Northside Imaging LLC

  • Diagnostic Radiology Physician
  • St Petersburg, FL
National Provider Identifier
1063402279
Registry record updated Aug 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
NORTHSIDE IMAGING LLC
Practice address
6006 49TH St N
Ste 140
St Petersburg, FL 33709-2148
Phone
(727) 528-5900
Fax
(727) 528-5911
NPI assigned
Oct 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Lavelle Hardin
Title
Credentialing Coordinator
Phone
(615) 344-8203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

6006 49TH St N
Ste 140
St Petersburg, FL 33709-2148

Mailing address

6006 49TH St N
Ste 140
St Petersburg, FL 33709-2148
Phone (727) 528-5900

Other names 1

  • Northside Imaging Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northside Imaging Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6006 49th St N
Ste 140
St Petersburg, FL 33709
Phone (727) 528-5900

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1063402279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6006 49TH ST N",
            "address_2": "STE 140",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337092148",
            "telephone_number": "727-528-5900",
            "fax_number": "727-528-5911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6006 49TH ST N",
            "address_2": "STE 140",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337092148",
            "telephone_number": "727-528-5900",
            "fax_number": "727-528-5911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "HARDIN",
        "authorized_official_first_name": "LAVELLE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "615-344-8203",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.