SOUTHERN OPEN MRI INC (NPI# 1194795658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194795658 |
| Entity Type | Organization |
| Organization Name | SOUTHERN OPEN MRI INC |
| Other Organization Name | SOUTHERN OPEN IMAGING CENTER |
| Practice Address |
289 Sw Stonegate Ter Suite 102 Lake City FL 32024-3456 |
| Practice Telephone | 3867554788 |
| Practice Fax Number | 3867559980 |
| Mailing Telephone | 3867554788 |
| Mailing Fax Number | 3867559980 |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2008-02-19 |
| Authorized Official Name | MRS. LUCIA M DELAUZ-SAMI (VP/CEO/MANAGER) |
| Authorized Official Telephone | 3867554788 |
| Authorized Official Credential | RT(R) |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2471C3401X |
Radiologic Technologist Specialization: Computed Tomography |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 2471S1302X |
Radiologic Technologist Specialization: Sonography |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 2471M1202X |
Radiologic Technologist Specialization: Magnetic Resonance Imaging |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | VISTA HEALTH PLAN | B796 | 01 |
| FL | AVMED PROVIDER NUMBER | 271288 | 01 |
| FL | BLUE CROSS BLUE SHIELD | V2546 | 01 |
| FL | FIRST HEALTH PROVIDER NUM | 1736853 | 01 |
| FL | AETNA PROVIDER NUMBER | 5259706 | 01 |
| Other Name | Type Code |
|---|---|
| Southern Open Imaging Center | Doing Business As Name - Organization |
| Street Address |
289 SW STONEGATE TER SUITE 102 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32024-3456 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982216321 | Dm Rehab Core LLC | Clinic/Center | 289 Sw Stonegate Ter, Lake City, FL 32024-3456 | 2020-08-18 |
| 1396132213 | Lake City Cancer Care, LLC | Internal Medicine | 289 Sw Stonegate Ter, Suite 103, Lake City, FL 32024-3456 | 2015-04-17 |
| 1467607903 | Sara Daughtry Mcclain | Physical Therapy Assistant | 289 Sw Stonegate Ter, Suite 101, Lake City, FL 32024-3457 | 2008-11-25 |
| 1285822981 | Internal Medicine of Lake City Pa | Clinic/Center | 289 Sw Stonegate Ter, Suite 104, Lake City, FL 32024-3456 | 2007-10-09 |
| 1073557864 | Waseem Khan | Internal Medicine | 289 Sw Stonegate Ter, Suite103, Lake City, FL 32024-3457 | 2006-06-15 |
| 1790728947 | Cancer Care of North Florida Pa | Internal Medicine | 289 Sw Stonegate Ter, Suite 103, Lake City, FL 32024-3457 | 2006-06-14 |
| 1073577169 | Jeffrey Leonard Foster | Physician Assistant | 289 Sw Stonegate Ter, Suite 103, Lake City, FL 32024-3457 | 2006-04-14 |
| 1750358073 | Shelia Y Roberts | Nurse Practitioner | 289 Sw Stonegate Ter, Suite 103, Lake City, FL 32024-3457 | 2006-03-06 |
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|---|---|---|---|---|
| 1083170534 | Sf Brevard, LLC | Skilled Nursing Facility | 298 Sw Prosperity Place, Lake City, FL 32024 | 2019-02-20 |
| 1689103079 | Vivian Robinson | Driver | 133 Sw Maereatha Ct, Lake City, FL 32024 | 2017-06-08 |
| 1508014630 | Stephen Lewis O'steen | Physical Therapy Assistant | 146 Sw Orthopaedic Court, Lake City, FL 32024 | 2008-09-03 |
| 1598965634 | Lake City Surgery Center, LLC | Clinic/Center | 208 Sw Prosperity Place, Lake City, FL 32024 | 2007-07-18 |
| 1932308145 | Smile Designs By Charlotte Gerry | Dentist | 857 Sw Main Blvd, Suite 105, Lake City, FL 32024 | 2007-07-17 |
| 1790900447 | Leopold Bejamin Leblique | General Practice | 264 Sw Ridgeview Pl., Lake City, FL 32024 | 2007-04-16 |
| 1073785911 | Rescare, Inc. | Intermediate Care Facility, Mentally Retarded | 1403 Spring St, Lake City, FL 32024 | 2008-04-01 |
| 1124202502 | Christina Mcghghy | Physical Therapy Assistant | 289 Sw Stonegate Terr, Suite #101, Lake City, FL 32024 | 2007-12-21 |
| 1629682133 | Paula Carol Palmer | Registered Nurse | 3857 Sw Birley Ave, Lake City, FL 32024-0003 | 2020-09-02 |
| 1831635176 | Patricia Vance | Chore Provider | 2238 Sw Salem Rd, Lake City, FL 32024-0029 | 2017-01-10 |
| Find all providers in zip 32024 | ||||
| Taxonomy Code | 2471M1202X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Magnetic Resonance Imaging |
| Definition to come... |
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| 1598213746 | Pines Imaging Center LLC | Radiologic Technologist | 9696 Pines Blvd, Pembroke Pines, FL 33024-6246 | 2016-09-16 |
| 1003280280 | Upright Open Mri, LLC | Radiologic Technologist | 18922-24 S Dixie Highway, Cutler Bay, FL 33157 | 2015-11-25 |
| 1073904876 | Mri Pluss Inc. | Radiologic Technologist | 9790 Sw 24 St, Miami, FL 33165 | 2015-02-16 |
| 1376834721 | Nog Diagostic | Radiologic Technologist | 3500hollywood Blvd, Hollywood, FL 33021 | 2011-04-20 |
| 1710115324 | Carol Beth Haring | Radiologic Technologist | 504 49th St E, Bradenton, FL 34208-5838 | 2009-06-23 |
| 1164676722 | Plantation Open Mri, LLC | Radiologic Technologist | 4331 N Federal Hwy Ste 200, Fort Lauderdale, FL 33308-5252 | 2008-11-10 |
| 1922263532 | Jacksonville Orthopaedic Institute Inc | Radiologic Technologist | 436 Jacksonville Dr, Jacksonville Beach, FL 32250-3812 | 2008-07-23 |
| 1891915583 | Clearview Imaging LLC | Radiologic Technologist | 3707 W Hamilton Ave, Tampa, FL 33614-4067 | 2007-04-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.