Provider Demographics
NPI:1811007701
Name:REGIONAL MRI OF ORLANDO
Entity Type:Organization
Organization Name:REGIONAL MRI OF ORLANDO
Other - Org Name:FIRST CHOICE IMAGING
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-455-7127
Mailing Address - Street 1:PO BOX 201668
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1668
Mailing Address - Country:US
Mailing Address - Phone:407-298-8989
Mailing Address - Fax:407-294-5750
Practice Address - Street 1:5200 DAVISSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-298-8989
Practice Address - Fax:407-294-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2696OtherBCBS
FLV1773OtherBCBS
FLE2667Medicare ID - Type Unspecified