Provider Demographics
NPI:1982909123
Name:PROFESSIONAL IMAGING CENTERS INC
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:407-493-3979
Mailing Address - Street 1:1049 WILLA SPRINGS DR
Mailing Address - Street 2:SUITE 1051
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5246
Mailing Address - Country:US
Mailing Address - Phone:407-657-7979
Mailing Address - Fax:407-678-9938
Practice Address - Street 1:225 W SR 434
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4980
Practice Address - Country:US
Practice Address - Phone:407-301-1000
Practice Address - Fax:407-678-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)