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General NPI Number Information
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NPI Number | 1003922832
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Entity Type | Organization
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Legal Business Name | AMERICAN RADIOLOGY SERVICES BANYAN CENTER LLC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 1350 TAMIAMI TRL N SUITE101
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City | NAPLES
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State | FL
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Zip | 34102-5203
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Country | US
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Telephone | 239-430-4674
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Fax | 239-263-8189
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Provider Business Mailing Address
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Address Line | 2338 IMMOKALEE RD SUITE 116
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 239-430-4674
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Fax | 239-263-8189
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK JOHN MARZANO
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Credential | MD
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Telephone | 239-430-4674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCC2420
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License Number State | FL
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