Provider Demographics
NPI:1679679955
Name:M R IMAGING SERVICES, INC
Entity Type:Organization
Organization Name:M R IMAGING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDET
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-335-2727
Mailing Address - Street 1:PO BOX 9615
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-9615
Mailing Address - Country:US
Mailing Address - Phone:772-335-2727
Mailing Address - Fax:772-429-3114
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:STE 10
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-335-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)