1366445397 NPI number — OPEN IMAGING, LC

Table of content: (NPI 1366445397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366445397 NPI number — OPEN IMAGING, LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN IMAGING, LC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RAYUS RADIOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366445397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 641895
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45264-1895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-674-7933
Provider Business Mailing Address Fax Number:
952-513-6880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6243 S REDWOOD RD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84123-6408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-288-9671
Provider Business Practice Location Address Fax Number:
801-288-9583
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAN KIRK
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
330-653-3968

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)