Prime Radiology of Winter Haven, Inc.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

ME62144 Issued in FL

Legal business name

PRIME RADIOLOGY OF WINTER HAVEN, INC.

Practice address

7524 Cypress Gardens Blvd
Winter Haven, FL 33884-3200

Phone

(850) 624-5666

Fax

(321) 348-5777

NPI assigned

Feb 27, 2015

Organization subpart

No

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

Authorized official

Name

Thomas Brown, M.D

Title

Medical Director

Phone

(850) 624-5666

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1424995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1669864658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7524 CYPRESS GARDENS BLVD",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338843200",
            "telephone_number": "850-624-5666",
            "fax_number": "321-348-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7524 CYPRESS GARDENS BLVD",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338843200",
            "telephone_number": "850-624-5666",
            "fax_number": "321-348-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME RADIOLOGY OF WINTER HAVEN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-27",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-624-5666",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME62144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME62144",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.