Basic Information
| Provider Information | |||||||||
| NPI: | 1508869397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN MRI OF MISSOURI II LLC | ||||||||
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| OtherOrganizationName: | NYDIC OPEN MRI OF AMERICA-INDEPENDENCE | ||||||||
| 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: | 2015058905 | ||||||||
| Practice Location | |||||||||
| Address1: | 3431 S HWY 291 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167956266 | ||||||||
| FaxNumber: | 8167956966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHWALTER | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| 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 | 428178 | 01 | MO | HEALTHLINK | OTHER | 11720 | 01 | MO | HEALTHCARE USA | OTHER | 2042557 | 01 | MO | AETNA HMO | OTHER | 24822013 | 01 | MO | BCBS OF KANSAS CITY | OTHER | 16-00435 | 01 | MO | UNITED HC OF THE MIDWEST | OTHER | 1151126 | 01 | MO | FIRST HEALTH NETWORK | OTHER | 742299 | 01 | MO | COVENTRY HC OF KANSAS | OTHER | 3987 | 01 | MO | FIRSTGUARD HEALTH PLAN | OTHER | 402227 | 01 | MO | BCBS OF KANSAS | OTHER | 5057623 | 01 | MO | AETNA PPOS | OTHER | 17065 | 01 | MO | MEDFOCUS | OTHER |