Basic Information
| Provider Information | |||||||||
| NPI: | 1740449784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A1 IMAGING OF ORLANDO LLC | ||||||||
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| OtherOrganizationName: | A1 IMAGING OF ORLANDO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 2ND ST | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342365946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413159876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 N SEMORAN BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328073381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072756072 | ||||||||
| FaxNumber: | 4072757301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 12/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | RADOKOVIC | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9512856661 | ||||||||
| 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.