Provider Demographics
NPI:1043494164
Name:CRESTVIEW MRI
Entity Type:Organization
Organization Name:CRESTVIEW MRI
Other - Org Name:CENTER OF IMAGING EXCELLENCE CRESTVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-536-3550
Mailing Address - Street 1:2003A WHITESBURG DR S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4543
Mailing Address - Country:US
Mailing Address - Phone:256-536-3550
Mailing Address - Fax:256-704-1535
Practice Address - Street 1:700 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539
Practice Address - Country:US
Practice Address - Phone:850-398-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology