MEDICARE: ARISTA IMAGING OF FORT MYERS 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

General Provider Information

NPI Number	:	1346414414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISTA IMAGING OF FORT MYERS LLC

Provider Business Mailing Address
First Line	:	700A KOEHLER AVE
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-7406
Country	:	US
Telephone Number	:	631-913-7000
Fax Number	:	631-580-5070

Provider Business Practice Location Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:	SUITE 182
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:	239-936-3332
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. MARTIN JOSEPH FARRELL
Credential	:
Telephone Number	:	631-913-7000

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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