Daytona MRI LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

DAYTONA MRI LLC

Practice address

125 Mason Ave
Daytona Beach, FL 32117-5017

Phone

(386) 463-4444

Fax

(386) 313-0304

NPI assigned

Mar 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Johnathan Livingston Wagner, D.C

Title

Owner

Phone

(386) 463-4444

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496188800000",
    "number": "1316309800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175017",
            "telephone_number": "386-463-4444",
            "fax_number": "386-313-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175017",
            "telephone_number": "386-463-4444",
            "fax_number": "386-313-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYTONA MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2017-05-31",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "LIVINGSTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-463-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "2471C3402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Radiography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1881628220",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Suzan De Feo, APRN
• Crystal De la Rosa, RN

• Physiological Laboratory in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Physiological Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.