Healthcare Provider Details

I. General information

NPI: 1881697407
Provider Name (Legal Business Name): CENTRAL IMAGING OPEN MRI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 CENTRAL AVE
ST PETERSBURG FL
33710-8529
US

IV. Provider business mailing address

PO BOX 946609
ATLANTA GA
30394-6609
US

V. Phone/Fax

Practice location:
  • Phone: 727-381-4674
  • Fax: 727-341-1182
Mailing address:
  • Phone: 727-381-4674
  • Fax: 727-341-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC3718
License Number StateFL

VIII. Authorized Official

Name: MR. MATTHEW A BROWN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 727-381-4674