MEDICARE: MRI AND 3D DIAGNOSTIC CENTER 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

General Provider Information

NPI Number	:	1467336263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MRI AND 3D DIAGNOSTIC CENTER LLC

Provider Business Mailing Address
First Line	:	7158 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6751
Country	:	US
Telephone Number	:	407-601-3604
Fax Number	:	407-412-5115

Provider Business Practice Location Address
First Line	:	7158 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6751
Country	:	US
Telephone Number	:	407-601-3604
Fax Number	:	407-412-5115

Authorized Official
Title or Position	:	ASSISTANT
Name	:	MS. STACY A MASTROSIMONE
Credential	:
Telephone Number	:	561-392-3341

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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