Provider Demographics
NPI:1043279839
Name:MIDWEST OPEN MRI INC
Entity Type:Organization
Organization Name:MIDWEST OPEN MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:816-478-4422
Mailing Address - Street 1:PO BOX 413022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-3022
Mailing Address - Country:US
Mailing Address - Phone:913-234-1494
Mailing Address - Fax:913-234-1116
Practice Address - Street 1:17020 E 40 HWY #4
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5361
Practice Address - Country:US
Practice Address - Phone:816-478-4422
Practice Address - Fax:816-478-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200308440AMedicaid
KS9004229AMedicare PIN
KS200308440AMedicaid