Provider Demographics
NPI:1033173687
Name:OPEN MRI OF MARSHALL LLC
Entity Type:Organization
Organization Name:OPEN MRI OF MARSHALL LLC
Other - Org Name:SAND MOUNTAIN OPEN MRI LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:O
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:478-474-2360
Mailing Address - Street 1:PO BOX 4003
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208
Mailing Address - Country:US
Mailing Address - Phone:478-755-9966
Mailing Address - Fax:478-755-9964
Practice Address - Street 1:12119 US HWY 431 SOUTH
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-894-4440
Practice Address - Fax:256-894-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCH1665Medicare PIN