Provider Demographics
NPI:1568748333
Name:MRI ASSOCIATES OF ST. PETERSBURG
Entity Type:Organization
Organization Name:MRI ASSOCIATES OF ST. PETERSBURG
Other - Org Name:SAINT PETE MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:727-577-2220
Mailing Address - Street 1:750 94TH AVE N
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2453
Mailing Address - Country:US
Mailing Address - Phone:727-577-2220
Mailing Address - Fax:727-577-7230
Practice Address - Street 1:750 94TH AVE N
Practice Address - Street 2:SUITE 206
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2453
Practice Address - Country:US
Practice Address - Phone:727-577-2220
Practice Address - Fax:727-577-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3960261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276042800Medicaid
FL276042800Medicaid