Provider Demographics
NPI:1497927768
Name:PHYSICIANS OPEN MRI LLC
Entity Type:Organization
Organization Name:PHYSICIANS OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BYRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-9828
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0117
Mailing Address - Country:US
Mailing Address - Phone:256-737-9828
Mailing Address - Fax:256-739-5893
Practice Address - Street 1:620 QUINTARD DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1840
Practice Address - Country:US
Practice Address - Phone:256-737-9828
Practice Address - Fax:256-739-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554575Medicare UPIN