Healthcare Provider Details

I. General information

NPI: 1730268632
Provider Name (Legal Business Name): NORTH FLORIDA OUTPATIENT IMAGING CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 NW 9TH BLVD
GAINESVILLE FL
32605-4206
US

IV. Provider business mailing address

6605 NW 9TH BLVD
GAINESVILLE FL
32605-4206
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4703
  • Fax: 352-333-5942
Mailing address:
  • Phone: 352-333-4703
  • Fax: 352-333-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberEXEMPT
License Number StateFL

VIII. Authorized Official

Name: MONICA DELEO
Title or Position: CENTER DIRECTOR
Credential:
Phone: 352-333-4703