Provider Demographics
NPI:1821156662
Name:TOMOKA DIAGNOSTIC INC.
Entity Type:Organization
Organization Name:TOMOKA DIAGNOSTIC INC.
Other - Org Name:TOMOKA MOBILE MRI INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:ORTOLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-274-3620
Mailing Address - Street 1:1510 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4549
Mailing Address - Country:US
Mailing Address - Phone:386-274-5676
Mailing Address - Fax:386-274-3605
Practice Address - Street 1:1510 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4549
Practice Address - Country:US
Practice Address - Phone:386-274-5676
Practice Address - Fax:386-274-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR37249002471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty