10D2163630 CLIA NUMBER - SIMONMED IMAGING FLORIDA, LLC DBA SIMONMED IMAGING - MACDILL

Laboratory Demographics

CLIA Number: 10D2163630

Facility Name: SIMONMED IMAGING FLORIDA, LLC DBA SIMONMED IMAGING - MACDILL

Facility Address:
110 S MACDILL
TAMPA, FL
ZIP 33609
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Facility Phone Number: 480 428-5604

Facility Type: Other - OP MEDICAL IMAGING

Certificate Type: Waiver

NPI Number: 1518537455

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D2163630
LAB Type	Other - OP MEDICAL IMAGING
Facility Name	SIMONMED IMAGING FLORIDA, LLC DBA SIMONMED IMAGING - MACDILL
Street	110 S MACDILL
City	TAMPA
State	FL
ZIP	33609
Phone	480 428-5604
CertificateType	4
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024