MEDICARE: ADVANCED IMAGING CENTER OF LEESBURG,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	261QR0200X	Radiology Clinic/Center	JR36381000	FL

General Provider Information

NPI Number	:	1881838670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED IMAGING CENTER OF LEESBURG,LLC

Provider Business Mailing Address
First Line	:	PO BOX 493854
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-3854
Country	:	US
Telephone Number	:
Fax Number	:

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	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	LESLIE J OLANDER
Credential	:
Telephone Number	:	352-435-0111

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	06/15/2009

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