1750349015 NPI number — ASHEVILLE OPEN MRI LLC

Table of content: (NPI 1750349015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750349015 NPI number — ASHEVILLE OPEN MRI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHEVILLE 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:
OPEN MRI OF ASHEVILLE
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:
1750349015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933393
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:
31193-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-659-1211
Provider Business Mailing Address Fax Number:
336-774-1751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 BILTMORE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-250-0181
Provider Business Practice Location Address Fax Number:
828-250-0142
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
SVP FINANCE AND REVENUE CYCLE
Authorized Official Telephone Number:
678-992-7255

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 371938800 . This is a "DOL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890197F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00351051 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0197F . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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