Provider Demographics
NPI:1003075474
Name:A1 IMAGING OF CAPE CORAL LLC
Entity Type:Organization
Organization Name:A1 IMAGING OF CAPE CORAL LLC
Other - Org Name:A1 IMAGING OF CAPE CORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
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 1:1003 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 102
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3601
Practice Address - Country:US
Practice Address - Phone:239-573-6333
Practice Address - Fax:239-573-8674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A1 IMAGING CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBO486Medicare PIN