Provider Demographics
NPI:1881838670
Name:ADVANCED IMAGING CENTER OF LEESBURG,LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING CENTER OF LEESBURG,LLC
Other - Org Name:ADVANCED IMAGING CENTER OF CLERMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-435-0111
Mailing Address - Street 1:PO BOX 493854
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-3854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:262 MOHAWK RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-7433
Practice Address - Country:US
Practice Address - Phone:352-243-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR36381000261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4542AMedicare PIN