Basic Information
Provider Information
NPI: 1043624174
EntityType: 2
ReplacementNPI:  
OrganizationName: A1 IMAGING CENTERS, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: A1 IMAGING OF NAPLES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2 N TAMIAMI TRL
Address2: SUITE 210
City: SARASOTA
State: FL
PostalCode: 342365574
CountryCode: US
TelephoneNumber: 9419253490
FaxNumber: 9419254914
Practice Location
Address1: 1350 TAMIAMI TRL N
Address2: SUITE 101
City: NAPLES
State: FL
PostalCode: 341025209
CountryCode: US
TelephoneNumber: 2394304674
FaxNumber: 2392638189
Other Information
ProviderEnumerationDate: 06/17/2014
LastUpdateDate: 06/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RADAKOVIC
AuthorizedOfficialFirstName: MARILYN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: TREASURER
AuthorizedOfficialTelephone: 9512856661
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: A1 IMAGING CENTERS, LLC
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM1200X  Y Ambulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)

No ID Information.


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