1417928409 NPI number — OPEN MRI OF SYLACAUGA, LLC

Table of content: (NPI 1417928409)

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:
OPEN MRI OF SYLACAUGA
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:
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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