Basic Information
| Provider Information | |||||||||
| NPI: | 1114150034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNSTON MRI LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 N BRIGHTLEAF BLVD | ||||||||
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| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199387595 | ||||||||
| FaxNumber: | 9199387069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2138 NC HWY 42 W | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275208343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195858000 | ||||||||
| FaxNumber: | 9199896584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2009 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | WAKEFIELD | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9199387113 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOHNSTON MEMORIAL HOSPITAL AUTHORITY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RM1200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Magnetic Resonance Imaging (MRI) |
No ID Information.