Provider Demographics
NPI:1689372179
Name:OPEN MRI OF DOUGLAS LLC
Entity Type:Organization
Organization Name:OPEN MRI OF DOUGLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:VALENE
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:RT(MR)
Authorized Official - Phone:912-393-1144
Mailing Address - Street 1:1315 OCILLA RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2213
Mailing Address - Country:US
Mailing Address - Phone:912-393-1144
Mailing Address - Fax:912-393-1124
Practice Address - Street 1:1315 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2213
Practice Address - Country:US
Practice Address - Phone:912-393-1144
Practice Address - Fax:912-393-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology