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General NPI Number Information
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NPI Number | 1790788875
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Entity Type | Organization
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Legal Business Name | MEDFUND LLC
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 SE 17TH ST STE 102
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City | OCALA
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State | FL
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Zip | 34471-4434
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Country | US
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Telephone | 352-622-7459
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Fax | 352-622-9238
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Provider Business Mailing Address
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Address Line | 240 N WASHINGTON BLVD
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City | SARASOTA
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State | FL
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Zip | 34236-5945
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Country | US
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Telephone | 941-925-3490
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Fax | 941-953-4452
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. MARTIN J KERN
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Credential |
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Telephone | 941-925-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | HCC5200
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License Number State | FL
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