Provider Demographics
NPI:1801867890
Name:OPEN MRI ON 280, LLC
Entity Type:Organization
Organization Name:OPEN MRI ON 280, LLC
Other - Org Name:IMAGESOUTH HOMEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-256-3450
Mailing Address - Street 1:PO BOX 932602
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2602
Mailing Address - Country:US
Mailing Address - Phone:205-870-1979
Mailing Address - Fax:205-870-1929
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 140
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2629
Practice Address - Country:US
Practice Address - Phone:205-870-1979
Practice Address - Fax:205-870-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1600679OtherUHC - PROVIDER NUMBER
AL1124000344OtherRUTH SNOW, MD
AL1235111451OtherDR. CECIL ELAND - NPI NUMBER
AL529913290Medicaid
AL1427030642OtherROBERT EICHELBERGER, MD
AL470001761OtherRAILROAD MEDICARE
AL1023040409OtherN. MELINDA BERGQUIST, MD
AL1306051164OtherJAMES SPANN, M.D, NPI #
AL51511247OtherBCBS - FACILITY ID #
AL51116995OtherJAMES SPANN, M.D. - BCBS ID #
AL1023040409OtherN. MELINDA BERGQUIST, MD
AL051511247Medicare ID - Type Unspecified