Provider Demographics
NPI:1609217561
Name:SADI
Entity Type:Organization
Organization Name:SADI
Other - Org Name:MARIANNA OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOMBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-526-2496
Mailing Address - Street 1:3015 JEFFERSON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2339
Mailing Address - Country:US
Mailing Address - Phone:850-526-2496
Mailing Address - Fax:850-526-3853
Practice Address - Street 1:3015 JEFFERSON ST
Practice Address - Street 2:SUITE E
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2339
Practice Address - Country:US
Practice Address - Phone:850-526-2496
Practice Address - Fax:850-526-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047944606Medicaid