Healthcare Provider Details

I. General information

NPI: 1235184011
Provider Name (Legal Business Name): OPEN MRI OF PINELLAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SEMINOLE BLVD SUITE 101
SEMINOLE FL
33772-2562
US

IV. Provider business mailing address

9555 SEMINOLE BLVD SUITE 101
SEMINOLE FL
33772-2562
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-5999
  • Fax: 727-398-1990
Mailing address:
  • Phone: 727-398-5999
  • Fax: 727-398-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number02736-01
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberJR 3911800
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberJR 4010100
License Number StateFL

VIII. Authorized Official

Name: JOAN JANET CARVAJAL
Title or Position: OWNER
Credential:
Phone: 727-398-5999