1417928409 NPI number — OPEN MRI OF SYLACAUGA, 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 1417928409 NPI number — OPEN MRI OF SYLACAUGA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF SYLACAUGA, 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:
6
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:
1417928409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933108
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:
31193-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-995-9899
Provider Business Mailing Address Fax Number:
205-995-1255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 JAMES PAYTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-8064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-207-2686
Provider Business Practice Location Address Fax Number:
256-207-2551
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
205-995-9388

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: 1124000344 . This is a "RUTH SNOW, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1235111451 . This is a "CECIL EILAND, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00206200 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1427030642 . This is a "ROBERT EICHELBERGER, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1730146069 . This is a "MARK CONNELL, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 529925390 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023040409 . This is a "N. MELINDA BERGQUIST, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1598747719 . This is a "THOMAS HARRELL, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51530056 . This is a "BCBS - FACILITY PROVIDER ID NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1659353886 . This is a "DONALD REYNOLDS, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1942282173 . This is a "PAMELA KULBACK, MD" identifier . This identifiers is of the category "OTHER".




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