Provider Demographics
NPI:1649916594
Name:ADVENTHEALTH IMAGING TRAINING CENTER
Entity type:Organization
Organization Name:ADVENTHEALTH IMAGING TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-200-2227
Mailing Address - Street 1:25 SOUTH TERRY AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805
Mailing Address - Country:US
Mailing Address - Phone:407-641-2446
Mailing Address - Fax:407-641-2447
Practice Address - Street 1:25 SOUTH TERRY AVE
Practice Address - Street 2:STE 220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-641-2446
Practice Address - Fax:407-641-2447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center