Provider Demographics
NPI:1841936879
Name:ADVENTHEALTH IMAGING CENTER INNOVATION
Entity type:Organization
Organization Name:ADVENTHEALTH IMAGING CENTER INNOVATION
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 1:265 E ROLLINS ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32084
Mailing Address - Country:US
Mailing Address - Phone:407-303-1414
Mailing Address - Fax:
Practice Address - Street 1:265 E ROLLINS ST
Practice Address - Street 2:STE 1000
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32084
Practice Address - Country:US
Practice Address - Phone:407-303-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center