1275570848 NPI number — OPEN MRI OF MICHIGAN LLC

Table of content: (NPI 1275570848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275570848 NPI number — OPEN MRI OF MICHIGAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF MICHIGAN LLC
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:
Provider Other Organization Name Type Code:
6
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:
1275570848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000
Provider Second Line Business Mailing Address:
DEPARTMENT 18401
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-228-4607
Provider Business Mailing Address Fax Number:
586-228-4666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 W 13 MILE RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
MADISON HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48071-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-585-4569
Provider Business Practice Location Address Fax Number:
248-585-4620
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JESMORE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CORPORATE DIRECTOR
Authorized Official Telephone Number:
586-226-6987

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0F30087 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8265 . This is a "CAPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P116959 . This is a "BCN OLD PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0N68190 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139709 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7282452 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001269 . This is a "MIDWEST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 135843 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8263818 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: QMXPR0021565 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M1670 . This is a "ONE CALL MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: RA16206 . This is a "MCARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com