# FT WALTON OPEN MRI LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992757678
- **Authorized official:** KEITH FREUDENBERGER (MANAGER MEMBER)
- **Authorized official phone:** (850) 862-7070

## Contact information

- **Practice address:** 1112 HOSPITAL RD, SUITE B, FORT WALTON BEACH, FL 32547-6742
- **Practice address phone:** (850) 862-7070
- **Practice address fax:** (850) 862-0900
- **Mailing address:** 1112 HOSPITAL RD, SUITE B, FORT WALTON BEACH, FL 32547-6742
- **Mailing address phone:** (850) 862-7070
- **Mailing address fax:** (850) 862-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | HCC4491 | FL | Yes |

## Other

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