Provider Demographics
NPI:1396716387
Name:MADISON OPEN MRI, LLC
Entity type:Organization
Organization Name:MADISON OPEN MRI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-732-1043
Mailing Address - Street 1:1401 SHOP RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4843
Mailing Address - Country:US
Mailing Address - Phone:803-988-1093
Mailing Address - Fax:803-929-0703
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8999
Practice Address - Country:US
Practice Address - Phone:256-461-8808
Practice Address - Fax:256-461-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023091972OtherALEX CHAN, MD
AL1235344011OtherNPI - CLINTON R. WAGGONER
1255314118OtherJOHN COLLINS, MD
1427031277OtherJOHN ROMER, MD
AL1669505368OtherRODERICK ZALAMEA, M.D.
1679519136OtherTAMERA MATHERNE, MD
1912980954OtherJOHN WESTER, MD
AL1942397922OtherRONALD WORKMAN, MD
GAP00296819OtherRAILROAD MEDICARE
1144203134OtherPAUL FRY, MD
1508848607OtherRAYMOND ARMSTRONG, MD
1952384943OtherGREGORY GUM, MD
1962685102OtherLEON BELL, MD
1003873951OtherDANA TOMALTY, MD
1033192034OtherALEX JOHNSON, MD
1437175429OtherPHILIP CHAPMAN, MD
AL529924970Medicaid
1316920267OtherTHOMAS BELL, MD
1851374607OtherDOUGLAS SUTHERLAND, MD
1902920267OtherKATHERINE MONTGOMERY, MD
1306829155OtherMICHAEL SMITH, MD
1942283932OtherSTEPHANIE JIMINEZ, MD
1952367120OtherJOSEPH SCALES, MD
AL51536709OtherBCBS OF ALABAMA
1023091857OtherDARRIN JOHNSON, MD
1356324586OtherTIMOTHY BAKER, MD
1417930660OtherRICHARD COLEMAN, MD
1487637427OtherSCOTT TUCKER, MD
1669505368OtherRODERICK ZALAMEA, MD
1154303246OtherROBERT AKENHEAD, MD
1174506166OtherKATHLEEN FELKER, MD
1710097399OtherWILLIAM LYNN, MD
AL1831246701OtherNPI - L. SHADINGER
1851374607OtherDOUGLAS SUTHERLAND, MD