NPIMap

Organization Active NPI

Manatee Diagnostic Center,LTD

  • Diagnostic Radiology Physician
  • Bradenton, FL
National Provider Identifier
1235406646
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME6540 Issued in FL
Legal business name
MANATEE DIAGNOSTIC CENTER,LTD
Practice address
2301 60TH Street Court West
Suite C
Bradenton, FL 34209
Phone
(941) 747-3034
Fax
(941) 748-5819
NPI assigned
Nov 30, 2011
Organization subpart
Yes
Parent organization
MANATEE DIAGNOSTIC CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

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

Authorized official

Name
David W Graham
Title
Exective Director/Cfo
Phone
(941) 747-3034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X ME6540 FL Primary

Addresses

Primary practice location

2301 60TH Street Court West
Suite C
Bradenton, FL 34209

Mailing address

2301 60TH Street Court West
Suite C
Bradenton, FL 34208
Phone (941) 747-3034

Other identifiers 1

IdentifierTypeStateIssuer
48245500MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Manatee Diagnostic Cent4 organizations share this tax ID, including this one
Part of
Manatee Diagnostic Cent

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1235406646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 60TH STREET COURT WEST",
            "address_2": "SUITE C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34208",
            "telephone_number": "941-747-3034",
            "fax_number": "941-748-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 60TH STREET COURT WEST",
            "address_2": "SUITE C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34209",
            "telephone_number": "941-747-3034",
            "fax_number": "941-748-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANATEE DIAGNOSTIC CENTER,LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MANATEE DIAGNOSTIC CENTER",
        "enumeration_date": "2011-11-30",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECTIVE DIRECTOR/CFO",
        "authorized_official_telephone_number": "941-747-3034"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME6540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48245500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; 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.