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General NPI Number Information
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NPI Number | 1881838670
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Entity Type | Organization
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Legal Business Name | ADVANCED IMAGING CENTER OF LEESBURG,LLC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 262 MOHAWK RD
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City | CLERMONT
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State | FL
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Zip | 34715-7433
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Country | US
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Telephone | 352-243-2111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 493854
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City | LEESBURG
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State | FL
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Zip | 34749-3854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | LESLIE J OLANDER
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Credential |
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Telephone | 352-435-0111
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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 | JR36381000
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License Number State | FL
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