1396716387 NPI number — MADISON OPEN MRI, LLC

Table of content: (NPI 1396716387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396716387 NPI number — MADISON OPEN MRI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON 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:
MADISON OPEN MRI
Provider Other Organization Name Type Code:
3
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:
1396716387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 SHOP RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-4843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-988-1093
Provider Business Mailing Address Fax Number:
803-929-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 HUGHES RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-8999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-461-8808
Provider Business Practice Location Address Fax Number:
256-461-8898
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-732-1043

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1023091972 . This is a "ALEX CHAN, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1235344011 . This is a "NPI - CLINTON R. WAGGONER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1255314118 . This is a "JOHN COLLINS, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1427031277 . This is a "JOHN ROMER, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1669505368 . This is a "RODERICK ZALAMEA, M.D." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1679519136 . This is a "TAMERA MATHERNE, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1912980954 . This is a "JOHN WESTER, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1942397922 . This is a "RONALD WORKMAN, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00296819 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1144203134 . This is a "PAUL FRY, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1508848607 . This is a "RAYMOND ARMSTRONG, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1952384943 . This is a "GREGORY GUM, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962685102 . This is a "LEON BELL, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003873951 . This is a "DANA TOMALTY, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1033192034 . This is a "ALEX JOHNSON, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1437175429 . This is a "PHILIP CHAPMAN, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 529924970 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316920267 . This is a "THOMAS BELL, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1851374607 . This is a "DOUGLAS SUTHERLAND, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1902920267 . This is a "KATHERINE MONTGOMERY, MD" identifier . This identifiers is of the category "OTHER".




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