Organization
FT WALTON OPEN MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH FREUDENBERGER (MANAGER MEMBER)
(850) 862-7070
Entity
Organization
Contact information
Practice address
1112 HOSPITAL RD, SUITE B, FORT WALTON BEACH, FL 32547-6742
(850) 862-7070
(850) 862-0900
Mailing address
1112 HOSPITAL RD, SUITE B, FORT WALTON BEACH, FL 32547-6742
(850) 862-7070
(850) 862-0900
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
HCC4491
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7010185
AETNA PROVIDER NO.
FL
01
—
V2836
BCBS FL PROVIDER NO.
FL
Enumeration date
05/17/2006
Last updated
06/17/2008
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