Basic Information
| Provider Information | |||||||||
| NPI: | 1386882272 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A1 IMAGING OF KISSIMMEE LLC | ||||||||
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| OtherOrganizationName: | A1 IMAGING OF KISSIMMEE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 N TAMIAMI TRAIL | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342365574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419253490 | ||||||||
| FaxNumber: | 9419534452 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 N JOHN YOUNG PKWY | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078476745 | ||||||||
| FaxNumber: | 4078478749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2009 | ||||||||
| LastUpdateDate: | 12/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | RADAKOVIC | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9513156661 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A1 IMAGING CENTERS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | HCC7759 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.