Provider Demographics
NPI:1831142728
Name:ADVANCED MAGNETIC IMAGING, INC
Entity Type:Organization
Organization Name:ADVANCED MAGNETIC IMAGING, INC
Other - Org Name:ANDALUSIA OPEN MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-377-3655
Mailing Address - Street 1:17423 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-3779
Mailing Address - Country:US
Mailing Address - Phone:334-222-1151
Mailing Address - Fax:334-222-1191
Practice Address - Street 1:580 W BYPASS
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4729
Practice Address - Country:US
Practice Address - Phone:334-222-1151
Practice Address - Fax:334-222-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51096417OtherBLUE CROSS BLUE SHIELD