Provider Demographics
NPI:1700873981
Name:AMIN RADIOLOGY INC
Entity Type:Organization
Organization Name:AMIN RADIOLOGY INC
Other - Org Name:CITRUS DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMALESH
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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 1:922 N CITRUS AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-3409
Practice Address - Country:US
Practice Address - Phone:352-795-9200
Practice Address - Fax:352-795-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271558900Medicaid
V2950OtherBCBS
K5374Medicare ID - Type Unspecified