Provider Demographics
NPI:1598700965
Name:OPEN MRI JASPER, LLC
Entity Type:Organization
Organization Name:OPEN MRI JASPER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-991-1830
Mailing Address - Street 1:301 N WALSTON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-8648
Mailing Address - Country:US
Mailing Address - Phone:205-387-0977
Mailing Address - Fax:
Practice Address - Street 1:301 N WALSTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-8648
Practice Address - Country:US
Practice Address - Phone:205-387-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000239261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1306051164OtherJAMES SPANN, M.D. - NPI #
AL1427030642OtherNPI - EICHELBERGER
AL51116988OtherJAMES SPANN, M.D. BCBS ID #
AL1023040409OtherNPI - BERGQUIST
AL1124000344OtherNPI - SNOW
AL1023040409OtherNPI - BERGQUIST