1851408512 NPI number — OPEN MRI OF AUBURN OPELIKA LLC

Table of content: (NPI 1851408512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851408512 NPI number — OPEN MRI OF AUBURN OPELIKA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF AUBURN OPELIKA 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:
1851408512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35804-8006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-533-2311
Provider Business Mailing Address Fax Number:
256-533-2231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 GATEWAY DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-5462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-533-2311
Provider Business Practice Location Address Fax Number:
256-533-2231
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
TOMMY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGING MEMBER CEO
Authorized Official Telephone Number:
256-533-2311

Provider Taxonomy Codes

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

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

  • Identifier: P00359806 . This is a "MEDICARE RR PALMETTO GBA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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