Provider Demographics
NPI:1255755245
Name:STAND UP OPEN MRI OF INDIANA LLC
Entity type:Organization
Organization Name:STAND UP OPEN MRI OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-433-0674
Mailing Address - Street 1:P.O. BOX 270543
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-0543
Mailing Address - Country:US
Mailing Address - Phone:219-513-1000
Mailing Address - Fax:219-513-1090
Practice Address - Street 1:509 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1643
Practice Address - Country:US
Practice Address - Phone:850-479-1805
Practice Address - Fax:850-479-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)