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Organization
FT WALTON OPEN MRI LLC
Active
Organization
FT WALTON OPEN MRI LLC
Active
Other names
Airis Open MRI of Marianna
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH FREUDENBERGER (MANAGER MEMBER)
(850) 862-7070
Entity
Organization
Contact information
Practice address
3015 JEFFERSON ST, SUITE E, MARIANNA, FL 32446-2339
(850) 526-2496
(850) 526-3853
Mailing address
3015 JEFFERSON ST, SUITE E, MARIANNA, FL 32446-2339
(850) 526-2496
(850) 526-3853
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
HCC4660
FL
261QR0200X
Radiology Clinic/Center
HCC4660
FL
Other
Enumeration date
05/18/2006
Last updated
06/17/2008
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