OPEN MRI OF FORT WALTON
Medical Practice at Mar Walt Dr, Fort Walton Beach, FL

License number
Florida 1357
Issued Date
May 2, 2002
Effective Date
Jul 11, 2004
Expiration Date
May 2, 2004
Category
Health Care
Type
Health Care Clinic Registration
Address
Address
908 Mar Walt Dr, Fort Walton Beach, FL 32547
LicenseFiles verified this license of Jun 1, 2017 at the Health Care Practitioner Data Portal.

Organization information

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OPEN MRI OF FORT WALTON, LLC

Fort Walton Beach, FL  -  Alpharetta, GA

Status:
Inactive
Industry:
Medical Laboratory
Inactive reason:
VOLUNTARY DISSOLUTION
Registration:
Jan 19, 2000
Inactive since:
Jan 22, 2002
Addresses:
908 Mar Walt Dr, Fort Walton Beach, FL 32547 (Physical)
4300 N Pt Pkwy, Alpharetta, GA 30022 (Mailing)
State ID:
L00000000642
Business type:
Florida Limited Liability Company
Secretarys:
John K Luke President, inactive, 4300 N Pt Pkwy, Alpharetta, GA 30022 (Physical),Gene Venesky CEO, inactive, 4300 N Pt Pkwy, Alpharetta, GA 30022 (Physical),Thomas C Gentry Secretary, inactive, 4300 N Pt Pkwy, Alpharetta, GA 30022 (Physical)
Agent:
John Luke,4511 N Davis Hwy, Pensacola, FL 32503 (Physical)
EIN:
593551727

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