Healthcare Provider Details

I. General information

NPI: 1386746212
Provider Name (Legal Business Name): REGIONAL MRI OF ORLANDO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 DAVISSON AVE STE B
ORLANDO FL
32810-5350
US

IV. Provider business mailing address

5200 DAVISSON AVE STE B
ORLANDO FL
32810-5350
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-8989
  • Fax: 407-294-5750
Mailing address:
  • Phone: 407-298-8989
  • Fax: 407-294-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberHCC5228
License Number StateFL

VIII. Authorized Official

Name: LESLIE G. WEBER
Title or Position: COO
Credential:
Phone: 858-455-7127