Provider Demographics
NPI:1871657148
Name:AMIN RADIOLOGY INC
Entity Type:Organization
Organization Name:AMIN RADIOLOGY INC
Other - Org Name:DUNNELLON OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-795-9200
Mailing Address - Street 1:922 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-3409
Mailing Address - Country:US
Mailing Address - Phone:352-795-9200
Mailing Address - Fax:352-795-6460
Practice Address - Street 1:11371 N WILLIAMS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8340
Practice Address - Country:US
Practice Address - Phone:352-489-8987
Practice Address - Fax:352-489-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055210174400000X
FLME0070251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271558901Medicaid
FLK5374Medicare ID - Type UnspecifiedGROUP #