Basic Information
| Provider Information | |||||||||
| NPI: | 1043279839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST OPEN MRI INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 413022 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641413022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132341494 | ||||||||
| FaxNumber: | 9132341116 | ||||||||
| Practice Location | |||||||||
| Address1: | 17020 E 40 HWY #4 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640555361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164784422 | ||||||||
| FaxNumber: | 8164787773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | HENLEY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8164784422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200308440A | 05 | KS | MEDICAID |