Provider Demographics
NPI:1992797823
Name:OPEN AIR MRI OF TROY LLC
Entity type:Organization
Organization Name:OPEN AIR MRI OF TROY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-291-9161
Mailing Address - Street 1:1001 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3849
Mailing Address - Country:US
Mailing Address - Phone:334-670-0927
Mailing Address - Fax:334-670-0928
Practice Address - Street 1:1001 S FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3849
Practice Address - Country:US
Practice Address - Phone:334-670-0927
Practice Address - Fax:334-670-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554529Medicaid
ALP00120848Medicare PIN
AL051554529Medicare PIN