NPIMap

Organization Active NPI

Enterprise Open MRI, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Enterprise, AL
National Provider Identifier
1740204346
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
ENTERPRISE OPEN MRI, LLC
Practice address
100 Professional Lane Suite B
Enterprise, AL 36330
Phone
(334) 308-1524
Fax
(334) 308-1528
NPI assigned
Jul 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
John C. Tomberlin, M.D.
Title
Owner
Phone
(334) 684-7156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

100 Professional Lane Suite B
Enterprise, AL 36330

Mailing address

194 E. Redstone Ave. Suite a
Crestview, FL 32539-5348
Phone (334) 684-7156

Other identifiers 2

IdentifierTypeStateIssuer
051519465OtherBLUE CROSS
051554517MedicaidAL

National Provider Directory

National Provider Directory

Locations

194 E Redstone Ave
Ste A
Crestview, FL 32539
Phone (850) 689-6705

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1740204346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 E. REDSTONE AVE. SUITE A",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395348",
            "telephone_number": "334-684-7156",
            "fax_number": "334-684-7709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL LANE SUITE B",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "36330",
            "telephone_number": "334-308-1524",
            "fax_number": "334-308-1528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTERPRISE OPEN MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "TOMBERLIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-684-7156",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051519465",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051554517",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.