=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033200332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED IMAGING CENTER OF LEESBURG LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 06/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13940 HIGHWAY 441 SUITE 201
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32159-8908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-750-1551
-----------------------------------------------------
Fax | 352-205-1551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13940 HIGHWAY 441 SUITE 201
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32159-8908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-750-1551
-----------------------------------------------------
Fax | 352-205-1551
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LESLIE J OLANDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-435-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------