Healthcare Provider Details

I. General information

NPI: 1316940323
Provider Name (Legal Business Name): MEDFUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9440 W COLONIAL DR STE 12
OCOEE FL
34761-6800
US

IV. Provider business mailing address

240 N WASHINGTON BLVD
SARASOTA FL
34236-5945
US

V. Phone/Fax

Practice location:
  • Phone: 407-822-0999
  • Fax: 407-822-0990
Mailing address:
  • Phone: 941-925-3490
  • Fax: 941-953-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberHCC5198
License Number StateFL

VIII. Authorized Official

Name: MISS MARTIN J KERN
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 941-925-3490