MEDICARE: A1 IMAGING CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC5217	FL

General Provider Information

NPI Number	:	1316185200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1 IMAGING CENTERS LLC

Provider Business Mailing Address
First Line	:	2 N TAMIAMI TRAIL
Second Line	:	SUITE 210
City	:	SARASOTA
State	:	FL
Zip	:	34236-5574
Country	:	US
Telephone Number	:	941-925-3490
Fax Number	:	941-953-4452

Provider Business Practice Location Address
First Line	:	500 N SEMORAN BLVD
Second Line	:	SUITE 103
City	:	ORLANDO
State	:	FL
Zip	:	32807-3381
Country	:	US
Telephone Number	:	407-275-6072
Fax Number	:	407-275-7301

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	TOM COLICCHIO
Credential	:
Telephone Number	:	909-887-8788

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	06/07/2011

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