1497958466 NPI number — NAVARRE OPEN MRI LLC

Table of content: (NPI 1497958466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497958466 NPI number — NAVARRE OPEN MRI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVARRE 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:
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:
1497958466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7552 NAVARRE PKWY
Provider Second Line Business Mailing Address:
SUITE 29
Provider Business Mailing Address City Name:
NAVARRE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32566-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-936-0911
Provider Business Mailing Address Fax Number:
850-936-6766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1112 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-6742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-862-7070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREUDENBERGER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
850-862-7070

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)