Provider Demographics
NPI:1346406006
Name:ADVANCED IMAGING CENTER OF LEESBURG LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING CENTER OF LEESBURG LLC
Other - Org Name:NAVARRE OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-435-0111
Mailing Address - Street 1:211 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5150
Mailing Address - Country:US
Mailing Address - Phone:352-435-0111
Mailing Address - Fax:352-787-6672
Practice Address - Street 1:7552 NAVARRE PKWY
Practice Address - Street 2:SUITE 29
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7305
Practice Address - Country:US
Practice Address - Phone:850-936-0911
Practice Address - Fax:850-936-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4542AMedicare PIN