Basic Information
| Provider Information | |||||||||
| NPI: | 1649273566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN MRI OF COLUMBUS, L.L.C. | ||||||||
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| OtherOrganizationName: | NYDIC OPEN MRI OF AMERICA-COLUMBUS | ||||||||
| 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: | 6096 E MAIN ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147515000 | ||||||||
| FaxNumber: | 6147510499 | ||||||||
| 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 | 0837-IC | OH | X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QM1200X | 0837-IC | OH | X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 1067796 | 01 | OH | FIRST HEALTH NETWORK | OTHER | 000000162279 | 01 | OH | ANTHEM | OTHER | 175273 | 01 | OH | UNISON | OTHER | 2433558 | 05 | OH | MEDICAID | 3364 | 01 | OH | MEDFOCUS | OTHER | 5688308 | 01 | OH | AETNA | OTHER |