1396716387 NPI number — MADISON 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 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:
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:
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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