Provider Demographics
NPI:1114150034
Name:JOHNSTON MRI LLC
Entity Type:Organization
Organization Name:JOHNSTON MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7113
Mailing Address - Street 1:509 N BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-938-7595
Mailing Address - Fax:919-938-7069
Practice Address - Street 1:2138 NC HWY 42 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8343
Practice Address - Country:US
Practice Address - Phone:919-585-8000
Practice Address - Fax:919-989-6584
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty