FT WALTON OPEN MRI LLC (NPI# 1992757678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992757678 |
| Entity Type | Organization |
| Organization Name | FT WALTON OPEN MRI LLC |
| Practice Address |
1112 Hospital Rd Suite B Fort Walton Beach FL 32547-6742 |
| Practice Telephone | 8508627070 |
| Practice Fax Number | 8508620900 |
| Mailing Telephone | 8508627070 |
| Mailing Fax Number | 8508620900 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-06-17 |
| Authorized Official Name | KEITH FREUDENBERGER (MANAGER MEMBER) |
| Authorized Official Telephone | 8508627070 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1200X |
Clinic/Center Specialization: Magnetic Resonance Imaging (MRI) |
HCC4491 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS FL PROVIDER NO. | V2836 | 01 |
| FL | AETNA PROVIDER NO. | 7010185 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760435267 | Ft Walton Open Mri LLC | Clinic/Center | 3015 Jefferson St, Suite E, Marianna, FL 32446-2339 | 2006-05-18 |
| Street Address |
1112 HOSPITAL RD SUITE B |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205804432 | Okaloosa Walton Urology Pa | Urology | 1112 Hospital Rd, Unit A, Fort Walton Beach, FL 32547-6655 | 2006-03-14 |
| 1528584745 | Hampton Dialysis LLC | Clinic/Center | 1112 Hospital Rd, Fort Walton Beach, FL 32547-6742 | 2017-08-18 |
| 1497958466 | Navarre Open Mri LLC | Clinic/Center | 1112 Hospital Rd, Suite B, Fort Walton Beach, FL 32547-6742 | 2007-06-07 |
| 1619920642 | Fort Walton Diagnostic Imaging Center LLC | Clinic/Center | 1112 Hospital Rd, Suite C, Fort Walton Beach, FL 32547-6742 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 261QM1200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Magnetic Resonance Imaging (MRI) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497958466 | Navarre Open Mri LLC | Clinic/Center | 1112 Hospital Rd, Suite B, Fort Walton Beach, FL 32547-6742 | 2007-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700176 | Mri Associates of Crystal River | Clinic/Center | 6136 W Gulf To Lake Hwy, Crystal River, FL 34429-7558 | 2020-11-04 |
| 1477168714 | Indago Imaging | Clinic/Center | 3716 W 12th Ave, Hialeah, FL 33012-4126 | 2020-09-14 |
| 1417577669 | Ahc Diagnostic and Imaging Services | Clinic/Center | 8000 Sw 67th Avenue, Miami, FL 33143 | 2020-04-17 |
| 1548880784 | Lee County Mri Inc | Clinic/Center | 2215 Winkler Ave Ste G, Fort Myers, FL 33901-9150 | 2020-04-17 |
| 1053942383 | Musculoskeletal Institute Chartered | Clinic/Center | 2044 Trinity Oaks Blvd Ste 110, Trinity, FL 34655-4405 | 2020-01-27 |
| 1407497647 | Proscan Imaging Naples LLC | Clinic/Center | 8340 Sierra Meadows Blvd Ste 103, Naples, FL 34113-7328 | 2019-09-30 |
| 1851940100 | Express Medical Imaging, LLC | Clinic/Center | 6300 Saint Johns Ave, Palatka, FL 32177-3884 | 2019-09-10 |
| 1104478601 | Flagler Mri Diagnostic Inc | Clinic/Center | 8000 W Flagler St Ste 102, Miami, FL 33144-2157 | 2019-07-15 |
| 1205497260 | South Miami Open Mri LLC | Clinic/Center | 6161 Sunset Dr Ste A, South Miami, FL 33143-5045 | 2019-06-21 |
| 1215592829 | Advance Scans & Imaging Center Inc. | Clinic/Center | 2453 N State Road 7, Lauderdale Lakes, FL 33313-3723 | 2019-05-08 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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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.