NPIMap

Organization Active NPI

South Brandon Imaging LLC

Doing business as Total Imaging of Robertson

  • Diagnostic Radiology Physician
  • Brandon, FL
National Provider Identifier
1114002094
Registry record updated Mar 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SOUTH BRANDON IMAGING LLC
Doing business as
Total Imaging of Robertson
Practice address
737 W Brandon Blvd
Brandon, FL 33511-4901
Phone
(813) 657-7575
Fax
(813) 684-3040
NPI assigned
Oct 26, 2006
Last updated
Mar 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2008

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

737 W Brandon Blvd
Brandon, FL 33511-4901

Mailing address

737 W Brandon Blvd
Brandon, FL 33511-4901
Phone (813) 657-7575

Other identifiers 1

IdentifierTypeStateIssuer
P00273457OtherFLRR MEDICARE

Other names 1

  • Total Imaging of Robertson Doing business as

National Provider Directory

National Provider Directory

Locations

737 W Brandon Blvd
Brandon, FL 33511
Phone (813) 657-7575

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1114002094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W BRANDON BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114901",
            "telephone_number": "813-657-7575",
            "fax_number": "813-684-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 W BRANDON BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114901",
            "telephone_number": "813-657-7575",
            "fax_number": "813-684-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BRANDON IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "HARDIN",
        "authorized_official_first_name": "LAVELLE",
        "authorized_official_title_or_position": "ENROLLMENT",
        "authorized_official_telephone_number": "615-344-8203",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00273457",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Total Imaging of Robertson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; 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.