1780687582 NPI number — HORIZON OPEN MRI OF PLANO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780687582 NPI number — HORIZON OPEN MRI OF PLANO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZON OPEN MRI OF PLANO 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:
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:
1780687582
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:
240 N WASHINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34236-5945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-925-3490
Provider Business Mailing Address Fax Number:
941-953-4452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3608 PRESTON RD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-467-6741
Provider Business Practice Location Address Fax Number:
469-467-6752
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KERN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
941-925-3490

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0335DC . This is a "BCBS PROV #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7441480 . This is a "AETNA/MEDSOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2241745 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".




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