Provider Demographics
NPI:1548420698
Name:A1 IMAGING OF FT WORTH LLC
Entity Type:Organization
Organization Name:A1 IMAGING OF FT WORTH LLC
Other - Org Name:A1 IMAGING OF FT WORTH
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 1:7440 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3904
Practice Address - Country:US
Practice Address - Phone:817-294-2400
Practice Address - Fax:817-294-2402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A1 IMAGING CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-12
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
TXFTX255Medicare PIN