Provider Demographics
NPI:1730268632
Name:NORTH FLORIDA OUTPATIENT IMAGING CENTER LTD
Entity type:Organization
Organization Name:NORTH FLORIDA OUTPATIENT IMAGING CENTER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-333-4703
Mailing Address - Street 1:6605 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4206
Mailing Address - Country:US
Mailing Address - Phone:352-333-4703
Mailing Address - Fax:352-333-5942
Practice Address - Street 1:6605 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4206
Practice Address - Country:US
Practice Address - Phone:352-333-4703
Practice Address - Fax:352-333-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPT2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4639Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID