NPIMap

Organization Active NPI

South Brandon Imaging LLC

  • Radiology Clinic/Center
  • Brandon, FL
National Provider Identifier
1124028824
Registry record updated Mar 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
SOUTH BRANDON IMAGING LLC
Practice address
737 W Brandon Blvd
Brandon, FL 33511-4901
Phone
(813) 657-7575
Fax
(813) 684-3040
NPI assigned
Jul 26, 2005
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
Credentialing Coordinator
Phone
(615) 344-8203

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X Primary
Mammography Clinic/Center 261QR0206X

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 Robertson Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1124028824",
    "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": "2005-07-26",
        "last_updated": "2008-03-18",
        "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": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00273457",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Total Imaging 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.