Provider Demographics
NPI:1841243714
Name:SOUTH BALDWIN OPEN MRI, LLC
Entity type:Organization
Organization Name:SOUTH BALDWIN OPEN MRI, LLC
Other - Org Name:
Other - Org Type:
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:251-377-5727
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 1:113 E FERN AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2806
Practice Address - Country:US
Practice Address - Phone:251-971-6630
Practice Address - Fax:251-971-6632
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