Provider Demographics
NPI:1689499865
Name:MARC IMAGING GROUP LLC
Entity type:Organization
Organization Name:MARC IMAGING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)(MR)
Authorized Official - Phone:407-312-5384
Mailing Address - Street 1:155528 WEST COLONIAL DRIVE
Mailing Address - Street 2:BUILDING F/SUITE A
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-674-9600
Mailing Address - Fax:407-557-9404
Practice Address - Street 1:15528 W COLONIAL DR STE A
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9567
Practice Address - Country:US
Practice Address - Phone:407-674-9600
Practice Address - Fax:407-557-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)