Provider Demographics
NPI:1225606296
Name:EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Entity Type:Organization
Organization Name:EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Other - Org Name:RADIOLOGY ASSOCIATES PORT ORANGE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-7118
Mailing Address - Street 1:PO BOX 678454
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5440 S. WILLIAMSON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128
Practice Address - Country:US
Practice Address - Phone:386-274-7118
Practice Address - Fax:386-274-6173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty