Provider Demographics
NPI:1881691020
Name:PREMIER OPEN MRI CENTER, L.C.
Entity type:Organization
Organization Name:PREMIER OPEN MRI CENTER, L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-396-6736
Mailing Address - Street 1:916 DANTE PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8419
Mailing Address - Country:US
Mailing Address - Phone:904-396-6736
Mailing Address - Fax:904-396-8601
Practice Address - Street 1:916 DANTE PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8419
Practice Address - Country:US
Practice Address - Phone:904-396-6736
Practice Address - Fax:904-396-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3839261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3424Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER