MEDICARE: ADVANCED IMAGING CENTER OF CLERMONT, INC.

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	261QR0200X	Radiology Clinic/Center	HCC4848	FL

General Provider Information

NPI Number	:	1831200211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED IMAGING CENTER OF CLERMONT, INC.

Provider Business Mailing Address
First Line	:	262 MOHAWK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-7433
Country	:	US
Telephone Number	:	352-243-2111
Fax Number	:	352-243-2112

Provider Business Practice Location Address
First Line	:	262 MOHAWK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-7433
Country	:	US
Telephone Number	:	352-243-2111
Fax Number	:	352-243-2112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROMAN DUBSKY
Credential	:
Telephone Number	:	407-927-1147

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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