Provider Demographics
NPI:1003922832
Name:AMERICAN RADIOLOGY SERVICES BANYAN CENTER LLC
Entity Type:Organization
Organization Name:AMERICAN RADIOLOGY SERVICES BANYAN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MARZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-430-4674
Mailing Address - Street 1:2338 IMMOKALEE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-430-4674
Mailing Address - Fax:239-263-8189
Practice Address - Street 1:1350 TAMIAMI TRL N
Practice Address - Street 2:SUITE101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5203
Practice Address - Country:US
Practice Address - Phone:239-430-4674
Practice Address - Fax:239-263-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC2420261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC42814Medicare UPIN