1528128790 NPI number — REGIONAL OPEN MRI, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528128790 NPI number — REGIONAL OPEN MRI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL OPEN MRI, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528128790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 932203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-256-3450
Provider Business Mailing Address Fax Number:
706-256-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2516 UNIVERSITY DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-595-4674
Provider Business Practice Location Address Fax Number:
706-597-0088
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
706-256-3450

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  041535 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00720398N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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