Provider Demographics
NPI:1902911977
Name:STAND UP MRI OF TAMPA,LLC
Entity type:Organization
Organization Name:STAND UP MRI OF TAMPA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-876-7200
Mailing Address - Street 1:2605 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3201
Mailing Address - Country:US
Mailing Address - Phone:813-876-7200
Mailing Address - Fax:813-876-7300
Practice Address - Street 1:2605 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3201
Practice Address - Country:US
Practice Address - Phone:813-876-7200
Practice Address - Fax:813-876-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC63722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER
FLU5070Medicare ID - Type Unspecified