Provider Demographics
NPI:1669469045
Name:MEDICAL IMAGING CENTER OF OCALA LLP
Entity Type:Organization
Organization Name:MEDICAL IMAGING CENTER OF OCALA LLP
Other - Org Name:MEDICAL IMAGING CENTER AT WINDSOR OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-671-4221
Mailing Address - Street 1:PO BOX 160716
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0716
Mailing Address - Country:US
Mailing Address - Phone:352-671-4300
Mailing Address - Fax:352-671-4393
Practice Address - Street 1:1490 SE MAGNOLIA EXT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4443
Practice Address - Country:US
Practice Address - Phone:352-671-4300
Practice Address - Fax:352-732-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061084400Medicaid
FL97993Medicare ID - Type Unspecified