1346255080 NPI number — OPEN MRI OF MILLEDGEVILLE LLC

Table of content: (NPI 1346255080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346255080 NPI number — OPEN MRI OF MILLEDGEVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF MILLEDGEVILLE 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:
1346255080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933274
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:
31193-3274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-560-7610
Provider Business Mailing Address Fax Number:
706-256-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 NORTH COLUMBIA STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31061-7113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-453-4101
Provider Business Practice Location Address Fax Number:
706-256-3454
Provider Enumeration Date:
07/30/2006

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: 247100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00307290 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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