Ft Walton Open MRI LLC

Primary specialty

Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X

License

HCC4491 Issued in FL

Legal business name

FT WALTON OPEN MRI LLC

Practice address

1112 Hospital Rd
Suite B
Fort Walton Beach, FL 32547-6742

Phone

(850) 862-7070

Fax

(850) 862-0900

NPI assigned

May 17, 2006

Last updated

Jun 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keith Freudenberger

Title

Manager Member

Phone

(850) 862-7070

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1992757678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 HOSPITAL RD",
            "address_2": "SUITE B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476742",
            "telephone_number": "850-862-7070",
            "fax_number": "850-862-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 HOSPITAL RD",
            "address_2": "SUITE B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476742",
            "telephone_number": "850-862-7070",
            "fax_number": "850-862-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT WALTON OPEN MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "FL",
            "license": "HCC4491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NO.",
            "identifier": "7010185",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL PROVIDER NO.",
            "identifier": "V2836",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Friend, OTR/L
• Edward M Frisbee, D.C.
• Karin Frisbee, D.C.
• Matthew McAdam Frisbee, D.C.
• Ft Walton Beach Internal Medicine LLC
• Ft. Walton Beach Anesthesia Services LLC
• Ft. Walton Beach General Surgery LLC
• Jacob Fuller
• Madeline Victoria Fullmer
• Denise Furlong, COTA

• Magnetic Resonance Imaging (MRI) Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Magnetic Resonance Imaging (MRI) Clinic/Center in Florida

• 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.