# FT WALTON OPEN MRI LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Airis Open MRI of Marianna
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760435267
- **Authorized official:** MR. KEITH FREUDENBERGER (MANAGER MEMBER)
- **Authorized official phone:** (850) 862-7070

## Contact information

- **Practice address:** 3015 JEFFERSON ST, SUITE E, MARIANNA, FL 32446-2339
- **Practice address phone:** (850) 526-2496
- **Practice address fax:** (850) 526-3853
- **Mailing address:** 3015 JEFFERSON ST, SUITE E, MARIANNA, FL 32446-2339
- **Mailing address phone:** (850) 526-2496
- **Mailing address fax:** (850) 526-3853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | HCC4660 | FL | Yes |
| 261QR0200X | Radiology Clinic/Center | HCC4660 | FL | — |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 06/17/2008