Provider Demographics
NPI:1114094307
Name:RICHLAND OPEN MRI LLC
Entity Type:Organization
Organization Name:RICHLAND OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-728-8307
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-0388
Mailing Address - Country:US
Mailing Address - Phone:318-728-4181
Mailing Address - Fax:318-728-8107
Practice Address - Street 1:254 HIGHWAY 3048
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-0388
Practice Address - Country:US
Practice Address - Phone:318-728-4181
Practice Address - Fax:318-728-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA28Medicare PIN