Basic Information
| Provider Information | |||||||||
| NPI: | 1124276431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A1 IMAGING II OF ORANGE PARK LLC | ||||||||
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| OtherOrganizationName: | OMI OF ORANGE PARK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 N TAMIAMI TRL | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342365574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419253490 | ||||||||
| FaxNumber: | 9419534452 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 KINGSLEY AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320735174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419253490 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 08/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | BABITZ | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9419253490 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A1 IMAGING CENTERS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.