Provider Demographics
NPI:1215175104
Name:A1 IMAGING CENTERS LLC
Entity type:Organization
Organization Name:A1 IMAGING CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-887-8788
Mailing Address - Street 1:2 N TAMIAMI TRL
Mailing Address - Street 2:STE 210
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5574
Mailing Address - Country:US
Mailing Address - Phone:941-925-3490
Mailing Address - Fax:941-953-4452
Practice Address - Street 1:9450 W COLONIAL DR
Practice Address - Street 2:SUITE 12
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6800
Practice Address - Country:US
Practice Address - Phone:407-822-0999
Practice Address - Fax:407-822-0990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A1 IMAGING CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7760261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)