1215175104 NPI number — A1 IMAGING CENTERS LLC

Table of content: (NPI 1215175104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215175104 NPI number — A1 IMAGING CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A1 IMAGING CENTERS 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:
Provider Other Organization Name Type Code:
6
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:
1215175104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2011
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:
STE 210
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:
9450 W COLONIAL DR
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
OCOEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34761-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-822-0999
Provider Business Practice Location Address Fax Number:
407-822-0990
Provider Enumeration Date:
01/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COLICCHIO
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF MANAGED CARE
Authorized Official Telephone Number:
909-887-8788

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  HCC7760 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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