MEDICARE: OPEN MRI OF PINELLAS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0206X	Mammography Clinic/Center	JR 4010100	FL
2	207X00000X	Orthopaedic Surgery Physician
3	261QR0200X	Radiology Clinic/Center	JR 3911800	FL
4	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	02736-01	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235184011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF PINELLAS, INC

Provider Business Mailing Address
First Line	:	9555 SEMINOLE BLVD
Second Line	:	SUITE 101
City	:	SEMINOLE
State	:	FL
Zip	:	33772-2562
Country	:	US
Telephone Number	:	727-398-5999
Fax Number	:	727-398-1990

Provider Business Practice Location Address
First Line	:	9555 SEMINOLE BLVD
Second Line	:	SUITE 101
City	:	SEMINOLE
State	:	FL
Zip	:	33772-2562
Country	:	US
Telephone Number	:	727-398-5999
Fax Number	:	727-398-1990

Authorized Official
Title or Position	:	OWNER
Name	:	JOAN JANET CARVAJAL
Credential	:
Telephone Number	:	727-398-5999

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	11/05/2019

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