Basic Information
| Provider Information | |||||||||
| NPI: | 1164475174 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN AIR MRI CENTERS MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910514 | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921910514 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6386 ALVARADO CT | ||||||||
| Address2: | 107 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921204905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192292299 | ||||||||
| FaxNumber: | 6192292288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROBINS | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6192292299 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | ZZZ06139Z | 01 | BLUE SHIELD | OTHER | ZZZ06141Z | 01 | BLUE SHIELD | OTHER | ZZZ06142Z | 01 | BLUE SHIELD | OTHER | ZZZ06136Z | 01 | BLUE SHIELD | OTHER | ZZZ6140Z | 01 | BLUE SHIELD | OTHER | ZZZ06137Z | 01 | BLUE SHIELD | OTHER | ZZZ06138Z | 01 | BLUE SHIELD | OTHER |