MEDICARE: SUNCOAST OPEN MRI LLC

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

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	:	1134188824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST OPEN MRI LLC

Provider Business Mailing Address
First Line	:	PO BOX 4003
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-4003
Country	:	US
Telephone Number	:	478-314-5009
Fax Number	:	478-755-9964

Provider Business Practice Location Address
First Line	:	511 E 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5307
Country	:	US
Telephone Number	:	850-747-8822
Fax Number	:	850-747-8664

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER O HOLLIDAY III
Credential	:	MD
Telephone Number	:	478-314-5013

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	05/26/2026

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Directions to “SUNCOAST OPEN MRI LLC ” Practice Location

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