NPIMap

Organization Active NPI

Ft Walton Open MRI LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Marianna, FL
National Provider Identifier
1760435267
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
License
HCC4660 Issued in FL
Legal business name
FT WALTON OPEN MRI LLC
Practice address
3015 Jefferson St
Suite E
Marianna, FL 32446-2339
Phone
(850) 526-2496
Fax
(850) 526-3853
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mr. Keith Freudenberger
Title
Manager Member
Phone
(850) 862-7070

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X HCC4660 FL Primary
Radiology Clinic/Center 261QR0200X HCC4660 FL

Addresses

Primary practice location

3015 Jefferson St
Suite E
Marianna, FL 32446-2339

Mailing address

3015 Jefferson St
Suite E
Marianna, FL 32446-2339
Phone (850) 526-2496

Other identifiers 2

IdentifierTypeStateIssuer
V2838OtherFLBCBS FL PROVIDER NO.
7010185OtherFLAETNA PROVIDER NO.

Other names 1

  • Airis Open MRI of Marianna 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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1760435267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 JEFFERSON ST",
            "address_2": "SUITE E",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324462339",
            "telephone_number": "850-526-2496",
            "fax_number": "850-526-3853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 JEFFERSON ST",
            "address_2": "SUITE E",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324462339",
            "telephone_number": "850-526-2496",
            "fax_number": "850-526-3853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT WALTON OPEN MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "FREUDENBERGER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "MANAGER MEMBER",
        "authorized_official_telephone_number": "850-862-7070",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "FL",
            "license": "HCC4660",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "HCC4660",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL PROVIDER NO.",
            "identifier": "V2838",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NO.",
            "identifier": "7010185",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Airis Open MRI of Marianna",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marianna, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.