MEDICARE: OPEN AIR MRI OF TROY 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	293D00000X	Physiological Laboratory

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	:	1992797823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN AIR MRI OF TROY LLC

Provider Business Mailing Address
First Line	:	1001 S FRANKLIN DR
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-3849
Country	:	US
Telephone Number	:	334-670-0927
Fax Number	:	334-670-0928

Provider Business Practice Location Address
First Line	:	1001 S FRANKLIN DR
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-3849
Country	:	US
Telephone Number	:	334-670-0927
Fax Number	:	334-670-0928

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JAMES W. HOLMES
Credential	:
Telephone Number	:	337-291-9161

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	02/13/2015

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