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General NPI Number Information
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NPI Number | 1265528467
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF JACKSON, LLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 1 LAYFAIR DR SUITE 315
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City | FLOWOOD
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State | MS
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Zip | 39232-9717
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Country | US
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Telephone | 601-936-6500
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Fax | 601-936-2027
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Provider Business Mailing Address
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Address Line | 1 LAYFAIR DR SUITE 315
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City | FLOWOOD
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State | MS
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Zip | 39232-9717
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Country | US
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Telephone | 601-936-6500
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Fax | 601-936-2027
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID BLUMENTHAL
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Credential |
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Telephone | 601-936-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | MS
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