1538328596 NPI number — A1 IMAGING OF ORMOND BEACH LLC

Table of content: (NPI 1538328596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538328596 NPI number — A1 IMAGING OF ORMOND BEACH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A1 IMAGING OF ORMOND BEACH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HORIZON ORMOND BEACH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538328596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 N TAMIAMI TRL
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34236-5574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-925-3490
Provider Business Mailing Address Fax Number:
941-953-4452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 CLYDE MORRIS BLVD
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-8130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-677-8680
Provider Business Practice Location Address Fax Number:
386-677-6895
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BABITZ
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
949-336-4336

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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