Provider Demographics
NPI:1235108259
Name:NASSAU OPEN MRI LLC
Entity Type:Organization
Organization Name:NASSAU OPEN MRI LLC
Other - Org Name:
Other - Org Type:
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 1:1699 SOUTH 14TH STREET
Practice Address - Street 2:SUITE 16
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-491-7700
Practice Address - Fax:904-491-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
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
FLV2799OtherBCBS
FLV2799OtherBCBS
FLP00179687Medicare PIN