Provider Demographics
NPI:1568422996
Name:MRI ASSOCIATES OF PALM HARBOR, INC
Entity Type:Organization
Organization Name:MRI ASSOCIATES OF PALM HARBOR, INC
Other - Org Name:PALM HARBOR MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-787-6900
Mailing Address - Street 1:32615 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3176
Mailing Address - Country:US
Mailing Address - Phone:727-787-6900
Mailing Address - Fax:727-787-2754
Practice Address - Street 1:32615 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 4
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3176
Practice Address - Country:US
Practice Address - Phone:727-787-6900
Practice Address - Fax:727-216-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3787261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5477442003OtherCIGNA
FL974079OtherAETNA
FLV2581OtherBC/BS
FL219693OtherAVMED
FL3405272OtherUNITED HEALTHCARE
FL630000865OtherRR MEDICARE
FL021547100Medicaid
FL219693OtherAVMED
FL271970300Medicaid