MEDICARE: A1 IMAGING OF KISSIMMEE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457511503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1 IMAGING OF KISSIMMEE LLC

Provider Business Mailing Address
First Line	:	1800 2ND ST
Second Line	:	SUITE 915
City	:	SARASOTA
State	:	FL
Zip	:	34236-5930
Country	:	US
Telephone Number	:	941-315-9876
Fax Number	:	941-953-4452

Provider Business Practice Location Address
First Line	:	810 N JOHN YOUNG PKWY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4912
Country	:	US
Telephone Number	:	407-847-6745
Fax Number	:	407-847-8749

Authorized Official
Title or Position	:	COO
Name	:	MARILYN RADAKOVIC
Credential	:
Telephone Number	:	951-385-6661

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	12/17/2014

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