Basic Information
| Provider Information | |||||||||
| NPI: | 1164425773 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN MRI OF DALLAS, L.C. | ||||||||
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| OtherOrganizationName: | NYDIC OPEN MRI OF AMERICA-DALLAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARAGON DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015738080 | ||||||||
| FaxNumber: | 2017754306 | ||||||||
| Practice Location | |||||||||
| Address1: | 8131 LBJ FWY | ||||||||
| Address2: | STE 100 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752511311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722317979 | ||||||||
| FaxNumber: | 9722319988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHWALTER | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2015738080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QM1200X | X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 4515729 | 01 | TX | AETNA US HEALTHCARE | OTHER | Z000N95T2 | 05 | TX | MEDICAID | 614622 | 01 | TX | AETNA US HEALTHCARE HMO | OTHER | 16-50184 | 01 | TX | UNITED HEALTHCARE | OTHER | 16863 | 01 | TX | NYLCARE HEALTH PLANS | OTHER | 797933 | 01 | TX | FIRST HEALTH NETWORK | OTHER | 0726388 | 01 | TX | AMERIHEALTH | OTHER | 0025DC | 01 | TX | BCBS OF TEXAS | OTHER | 3649 | 01 | TX | MEDFOCUS | OTHER | 825241 | 01 | TX | HEALTH SMART PREFERRED | OTHER |