Provider Demographics
NPI:1154411940
Name:NEW TAMPA IMAGING CENTER
Entity type:Organization
Organization Name:NEW TAMPA IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT OF OPERATIO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WYLIE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:813-657-4914
Mailing Address - Street 1:122 LINSLEY AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14302 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-975-1111
Practice Address - Fax:813-975-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography