Organization Active NPI

Fort Payne MRI LLC

  • Radiology Clinic/Center
  • Fort Payne, AL
National Provider Identifier
1730145988
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
FORT PAYNE MRI LLC
Practice address
1110 Glenn Blvd SW
Suite 100
Fort Payne, AL 35967-8486
Phone
(256) 845-9402
Fax
(256) 845-9410
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Authorized official

Name
James W. Holmes
Title
Chief Operating Officer
Phone
(337) 291-9161

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

1110 Glenn Blvd SW
Suite 100
Fort Payne, AL 35967-8486

Mailing address

1110 Glenn Blvd SW
Suite 100
Fort Payne, AL 35967-8486
Phone (256) 845-9402

Other identifiers 1

IdentifierTypeStateIssuer
051557560MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060530000225 AL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 0941211247 Practice locations: Fort Payne, AL

National Provider Directory

National Provider Directory

Locations

1110 Glenn Blvd SW
Ste 100
Fort Payne, AL 35967
Phone (256) 845-9402

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1730145988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 GLENN BLVD SW",
            "address_2": "SUITE 100",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359678486",
            "telephone_number": "256-845-9402",
            "fax_number": "256-845-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 GLENN BLVD SW",
            "address_2": "SUITE 100",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359678486",
            "telephone_number": "256-845-9402",
            "fax_number": "256-845-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT PAYNE MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "337-291-9161"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051557560",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Payne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.