Provider Demographics
NPI:1417928409
Name:OPEN MRI OF SYLACAUGA, LLC
Entity Type:Organization
Organization Name:OPEN MRI OF SYLACAUGA, LLC
Other - Org Name:OPEN MRI OF SYLACAUGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-995-9388
Mailing Address - Street 1:PO BOX 933108
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3108
Mailing Address - Country:US
Mailing Address - Phone:205-995-9899
Mailing Address - Fax:205-995-1255
Practice Address - Street 1:395 JAMES PAYTON BLVD
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-8064
Practice Address - Country:US
Practice Address - Phone:256-207-2686
Practice Address - Fax:256-207-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124000344OtherRUTH SNOW, MD
1235111451OtherCECIL EILAND, MD
GAP00206200OtherRAILROAD MEDICARE
1427030642OtherROBERT EICHELBERGER, MD
1730146069OtherMARK CONNELL, MD
AL529925390Medicaid
AL1023040409OtherN. MELINDA BERGQUIST, MD
1598747719OtherTHOMAS HARRELL, MD
AL51530056OtherBCBS - FACILITY PROVIDER ID NUMBER
1659353886OtherDONALD REYNOLDS, MD
1942282173OtherPAMELA KULBACK, MD
AL051555400Medicare ID - Type Unspecified