Provider Demographics
NPI:1033300330
Name:PROFESSIONAL IMAGING CENTERS INC
Entity type:Organization
Organization Name:PROFESSIONAL IMAGING CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-657-7979
Mailing Address - Street 1:911 E OAK ST
Mailing Address - Street 2:STE A
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5836
Mailing Address - Country:US
Mailing Address - Phone:407-847-3070
Mailing Address - Fax:407-847-2723
Practice Address - Street 1:911 E OAK STREET
Practice Address - Street 2:SUITE A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5836
Practice Address - Country:US
Practice Address - Phone:407-847-3070
Practice Address - Fax:407-678-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7787261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAT339Medicare PIN