Provider Demographics
NPI:1063594679
Name:NORTHSIDE IMAGING, LLC
Entity type:Organization
Organization Name:NORTHSIDE IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-344-2274
Mailing Address - Street 1:14108 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8595
Mailing Address - Country:US
Mailing Address - Phone:727-861-4490
Mailing Address - Fax:727-861-4491
Practice Address - Street 1:14108 GLACIER DRIVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-861-4490
Practice Address - Fax:727-861-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty