1851488068 NPI number — CENTERS FOR ADVANCED IMAGING INC

Table of content: (NPI 1851488068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851488068 NPI number — CENTERS FOR ADVANCED IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERS FOR ADVANCED IMAGING INC
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:
1851488068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 838
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32178-0838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-328-3559
Provider Business Mailing Address Fax Number:
386-328-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3918 CRILL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-328-3559
Provider Business Practice Location Address Fax Number:
386-328-3411
Provider Enumeration Date:
10/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDON
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
386-328-3559

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME68132 , 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)

  • Identifier: 2644754700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com