Organization
SOUTHERN OPEN MRI INC
Active
Organization
SOUTHERN OPEN MRI INC
Active
Other names
Southern Open Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUCIA M DELAUZ-SAMI RT(R) (VP/CEO/MANAGER)
(386) 755-4788
Entity
Organization
Contact information
Practice address
289 SW STONEGATE TER, SUITE 102, LAKE CITY, FL 32024-3456
(386) 755-4788
(386) 755-9980
Mailing address
289 SW STONEGATE TER, SUITE 102, LAKE CITY, FL 32024-3456
(386) 755-4788
(386) 755-9980
Taxonomy
Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
—
—
2471S1302X
Sonography Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1736853
FIRST HEALTH PROVIDER NUM
FL
01
—
271288
AVMED PROVIDER NUMBER
FL
01
—
5259706
AETNA PROVIDER NUMBER
FL
01
—
B796
VISTA HEALTH PLAN
FL
01
—
V2546
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/25/2006
Last updated
02/19/2008
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