Provider Demographics
NPI:1326040379
Name:FLORENCE MRI DIAGNOSTIC
Entity Type:Organization
Organization Name:FLORENCE MRI DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-764-2910
Mailing Address - Street 1:552 W ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6005
Mailing Address - Country:US
Mailing Address - Phone:256-764-2910
Mailing Address - Fax:256-764-2910
Practice Address - Street 1:552 W ALABAMA ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6005
Practice Address - Country:US
Practice Address - Phone:256-764-2910
Practice Address - Fax:256-764-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51081788OtherBC PROVIDER NUMBER
AL51507877OtherBC PROVIDER NUMBER
AL51081787OtherBC PROVIDER NUMBER
AL51519609OtherBC PROVICER NUMBER
AL51081787OtherBC PROVIDER NUMBER
AL51081788OtherBC PROVIDER NUMBER
C72664Medicare UPIN
C76161Medicare UPIN