Provider Demographics
NPI:1720226731
Name:A1 IMAGING CENTER LLC
Entity Type:Organization
Organization Name:A1 IMAGING CENTER LLC
Other - Org Name:A1 IMAGING OF ORANGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-887-8788
Mailing Address - Street 1:2 N TAMIAMI TRAIL
Mailing Address - Street 2:STE 210
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5574
Mailing Address - Country:US
Mailing Address - Phone:941-925-3490
Mailing Address - Fax:941-953-4452
Practice Address - Street 1:1566 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4511
Practice Address - Country:US
Practice Address - Phone:904-278-2128
Practice Address - Fax:904-278-2129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A1 IMAGING CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-29
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7772261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)