Provider Demographics
NPI:1073505848
Name:PREMIER OPEN MRI OF PLANO
Entity Type:Organization
Organization Name:PREMIER OPEN MRI OF PLANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-312-0799
Mailing Address - Street 1:2205 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2500
Mailing Address - Country:US
Mailing Address - Phone:972-312-0799
Mailing Address - Fax:972-312-8187
Practice Address - Street 1:2205 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2500
Practice Address - Country:US
Practice Address - Phone:972-312-0799
Practice Address - Fax:972-312-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX033Medicare ID - Type Unspecified