Provider Demographics
NPI:1851408512
Name:OPEN MRI OF AUBURN OPELIKA LLC
Entity Type:Organization
Organization Name:OPEN MRI OF AUBURN OPELIKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-2311
Mailing Address - Street 1:PO BOX 18006
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8006
Mailing Address - Country:US
Mailing Address - Phone:256-533-2311
Mailing Address - Fax:256-533-2231
Practice Address - Street 1:1441 GATEWAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5462
Practice Address - Country:US
Practice Address - Phone:256-533-2311
Practice Address - Fax:256-533-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00359806OtherMEDICARE RR PALMETTO GBA
ALP00359806OtherMEDICARE RR PALMETTO GBA