MEDICARE: NAVARRE 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

General Provider Information

NPI Number	:	1497958466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVARRE OPEN MRI LLC

Provider Business Mailing Address
First Line	:	7552 NAVARRE PKWY
Second Line	:	SUITE 29
City	:	NAVARRE
State	:	FL
Zip	:	32566-7305
Country	:	US
Telephone Number	:	850-936-0911
Fax Number	:	850-936-6766

Provider Business Practice Location Address
First Line	:	1112 HOSPITAL RD
Second Line	:	SUITE B
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6742
Country	:	US
Telephone Number	:	850-862-7070
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. KEITH FREUDENBERGER
Credential	:
Telephone Number	:	850-862-7070

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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