Provider Demographics
NPI:1114010873
Name:IOWA OPEN MRI
Entity Type:Organization
Organization Name:IOWA OPEN MRI
Other - Org Name:HAWKEYE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIAYONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-793-9655
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:DEPT 5299
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-1170
Mailing Address - Country:US
Mailing Address - Phone:219-793-9655
Mailing Address - Fax:219-793-9692
Practice Address - Street 1:1100 6TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-337-7458
Practice Address - Fax:319-337-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42645OtherBLUE CROSS BLUE SHIELD WELLMARK
IA4081794Medicaid
IA4081794Medicaid
IA42645OtherBLUE CROSS BLUE SHIELD WELLMARK