Provider Demographics
NPI:1235184011
Name:OPEN MRI OF PINELLAS, INC
Entity Type:Organization
Organization Name:OPEN MRI OF PINELLAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-398-5999
Mailing Address - Street 1:9555 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2562
Mailing Address - Country:US
Mailing Address - Phone:727-398-5999
Mailing Address - Fax:727-398-1990
Practice Address - Street 1:9555 SEMINOLE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2562
Practice Address - Country:US
Practice Address - Phone:727-398-5999
Practice Address - Fax:727-398-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
FL02736-01261QM1200X
FLJR 3911800261QR0200X
FLJR 4010100261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000E4044Medicare ID - Type UnspecifiedMEDICARE NUMBER