Provider Demographics
NPI:1437105780
Name:ADVANTAGE OPEN MRI INC
Entity Type:Organization
Organization Name:ADVANTAGE OPEN MRI INC
Other - Org Name:ADVANTAGE OUT PATIENT IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-343-6674
Mailing Address - Street 1:PO BOX 20724
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0724
Mailing Address - Country:US
Mailing Address - Phone:727-343-6674
Mailing Address - Fax:727-343-6675
Practice Address - Street 1:6705 38TH AVE N
Practice Address - Street 2:#A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-343-6674
Practice Address - Fax:727-343-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology