Provider Demographics
NPI:1053377861
Name:ORMOND RADIOLOGY PARTNERSHIP, L.L.C
Entity type:Organization
Organization Name:ORMOND RADIOLOGY PARTNERSHIP, L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES/CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:JT
Authorized Official - Middle Name:
Authorized Official - Last Name:TENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-8040
Mailing Address - Street 1:500 MEMORIAL CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OMROND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5054
Mailing Address - Country:US
Mailing Address - Phone:386-673-8040
Mailing Address - Fax:386-267-0693
Practice Address - Street 1:1680 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4754
Practice Address - Country:US
Practice Address - Phone:386-304-1212
Practice Address - Fax:386-304-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCG5244OtherRR MEDICARE GROUP #
FLV3001OtherBCBS GROUP NUMBER
FL40370BMedicare ID - Type Unspecified