Provider Demographics
NPI:1386991974
Name:MRI ASSOCIATES OF WINTER HAVEN LLC
Entity type:Organization
Organization Name:MRI ASSOCIATES OF WINTER HAVEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-787-6900
Mailing Address - Street 1:409 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3051
Mailing Address - Country:US
Mailing Address - Phone:863-294-0999
Mailing Address - Fax:863-294-0100
Practice Address - Street 1:409 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3051
Practice Address - Country:US
Practice Address - Phone:863-294-0999
Practice Address - Fax:863-294-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X, 261Q00000X
FLHCC9859261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113976600Medicaid
FLV00AVOtherBCBS
FLHCC9859OtherAGENCY FOR HEALTHCARE ADMINISTRATION