Healthcare Provider Details

I. General information

NPI: 1700392388
Provider Name (Legal Business Name): DIAGNOSTIC OUTPATIENT CENTERS OF OCALA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SE 17TH ST
OCALA FL
34471-3912
US

IV. Provider business mailing address

1030 SE 17TH ST
OCALA FL
34471-3912
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-3627
  • Fax: 352-401-0444
Mailing address:
  • Phone: 352-401-3627
  • Fax: 352-401-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHCC6260
License Number StateFL

VIII. Authorized Official

Name: LARRY J WILLIAMS
Title or Position: OWNER
Credential:
Phone: 727-896-2202