Open MRI of Orlando Inc

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

HCC5152 Issued in FL

Legal business name

OPEN MRI OF ORLANDO INC

Practice address

1879 Nightingale LN
Suite a-1
Tavares, FL 32778-4363

Phone

(352) 742-9211

Fax

(352) 742-9406

NPI assigned

Jun 6, 2006

Organization subpart

No

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

Authorized official

Name

Shaun P Woodburn

Title

President

Phone

(352) 742-9211

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeside Open MRI of Tavares Doing business as

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467491993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1879 NIGHTINGALE LN",
            "address_2": "SUITE A-1",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784363",
            "telephone_number": "352-742-9211",
            "fax_number": "352-742-9406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 NIGHTINGALE LN",
            "address_2": "SUITE A-1",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784363",
            "telephone_number": "352-742-9211",
            "fax_number": "352-742-9406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN MRI OF ORLANDO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOODBURN",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-742-9211"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "HCC5152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHEIL",
            "identifier": "V2544",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Open MRI of Tavares",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaquice Lavette Oliver, PMHNP-BC
• Richard Olton, PA-C
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• One More Light Counseling & Wellness LLC
• Open Arms TCM
• Abigail Oram
• Caitlin Marie Oris, ARNP
• Tatiana Ortega Hayes
• Faithful Osarekpama Osawe, MD
• Osprey Lodge LLC

• Radiology Clinic/Center in Tavares, FL
• Providers in Tavares, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.