Provider Demographics
NPI:1588070627
Name:A1 IMAGING OF SPRING PARK, LLC
Entity type:Organization
Organization Name:A1 IMAGING OF SPRING PARK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RADAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-285-6661
Mailing Address - Street 1:1800 2ND ST
Mailing Address - Street 2:SUITE 915
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5946
Mailing Address - Country:US
Mailing Address - Phone:941-315-9876
Mailing Address - Fax:
Practice Address - Street 1:5562 SPRING PARK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5549
Practice Address - Country:US
Practice Address - Phone:904-854-6741
Practice Address - Fax:904-425-3144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A1 IMAGING CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-09
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)