NPIMap

Organization Active NPI

Crestview Open MRI Inc

  • Diagnostic Radiology Physician
  • Crestview, FL
National Provider Identifier
1578863726
Registry record updated Nov 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CRESTVIEW OPEN MRI INC
Doing business as
CRESTVIEW OPEN MRI
Practice address
194 E Redstone Ave
Suite a
Crestview, FL 32539-5348
Phone
(850) 689-6705
Fax
(850) 689-6709
NPI assigned
Oct 21, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2015

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

Authorized official

Name
John Tomberlin, M.D.
Title
Medical Director
Phone
(334) 684-7156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

194 E Redstone Ave
Suite a
Crestview, FL 32539-5348

Mailing address

PO Box 23697
Jackson, MS 39225-3697
Phone (850) 689-6705

Other names 1

  • CRESTVIEW OPEN MRI Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447718400000",
    "number": "1578863726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23697",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253697",
            "telephone_number": "850-689-6705",
            "fax_number": "850-689-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 E REDSTONE AVE",
            "address_2": "SUITE A",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395348",
            "telephone_number": "850-689-6705",
            "fax_number": "850-689-6709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW OPEN MRI INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2015-11-17",
        "status": "A",
        "authorized_official_last_name": "TOMBERLIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "334-684-7156",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTVIEW OPEN MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; 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.