Healthcare Provider Details

I. General information

NPI: 1215602032
Provider Name (Legal Business Name): MEDICAL IMAGING CENTER OF OCALA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SE 18TH AVE STE 200
OCALA FL
34471-8214
US

IV. Provider business mailing address

PO BOX 160716
ALTAMONTE SPRINGS FL
32716-0716
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-4300
  • Fax:
Mailing address:
  • Phone: 800-841-4236
  • Fax: 706-653-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CALEB RUBEN RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 352-671-4221