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General NPI Number Information
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NPI Number | 1093087124
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Entity Type | Organization
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Legal Business Name | INNOVATIVE OPEN MRI OF PENSACOLA LLC
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 890 S. PALAFOX STREET SUITE 110
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City | PENSACOLA
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State | FL
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Zip | 32524-5905
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Country | US
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Telephone | 850-433-0674
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Fax | 850-433-5965
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Provider Business Mailing Address
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Address Line | 890 S. PALAFOX STREET SUITE 110
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City | PENSACOLA
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State | FL
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Zip | 32524-5905
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Country | US
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Telephone | 850-433-0674
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Fax | 850-433-5965
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Authorized Official
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Title or Position | OWNER,PHYSICIAN
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Name | DR. AARON BRYANT MONTGOMERY
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Credential | M.D.
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Telephone | 850-433-0674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State | FL
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