Provider Demographics
NPI:1831200211
Name:ADVANCED IMAGING CENTER OF CLERMONT, INC.
Entity type:Organization
Organization Name:ADVANCED IMAGING CENTER OF CLERMONT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-927-1147
Mailing Address - Street 1:262 MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7433
Mailing Address - Country:US
Mailing Address - Phone:352-243-2111
Mailing Address - Fax:352-243-2112
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:352-243-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4848261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3114Medicare ID - Type UnspecifiedIDTF