Provider Demographics
NPI:1578544615
Name:MRI ASSOCIATES OF TAMPA INC
Entity Type:Organization
Organization Name:MRI ASSOCIATES OF TAMPA INC
Other - Org Name:PARK PLACE MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-886-9999
Mailing Address - Street 1:6800 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 144
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3997
Mailing Address - Country:US
Mailing Address - Phone:813-886-9999
Mailing Address - Fax:813-885-2800
Practice Address - Street 1:6800 N DALE MABRY HWY
Practice Address - Street 2:SUITE 144
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3997
Practice Address - Country:US
Practice Address - Phone:813-886-9999
Practice Address - Fax:813-885-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC38042471C3402X
261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272861300Medicaid