MEDICARE: OPEN MRI OF AMERICA, INC

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	HCC4542	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38383	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1407899263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF AMERICA, INC

Provider Business Mailing Address
First Line	:	2401 FRIST BLVD
Second Line	:	STE 10
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4839
Country	:	US
Telephone Number	:	772-429-3113
Fax Number	:	772-429-3114

Provider Business Practice Location Address
First Line	:	2401 FRIST BLVD
Second Line	:	STE 10
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4839
Country	:	US
Telephone Number	:	772-429-3113
Fax Number	:	772-429-3114

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CARL D BLANTON
Credential	:
Telephone Number	:	772-429-3113

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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