Provider Demographics
NPI:1144409343
Name:ENVISION OPEN MRI LLC
Entity Type:Organization
Organization Name:ENVISION OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-467-5335
Mailing Address - Street 1:300 N 44TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3415
Mailing Address - Country:US
Mailing Address - Phone:402-467-5335
Mailing Address - Fax:
Practice Address - Street 1:300 N 44TH ST
Practice Address - Street 2:STE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3415
Practice Address - Country:US
Practice Address - Phone:402-467-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025579500Medicaid
NEP00629620OtherRR MEDICARE
NE01899001OtherBCBS OF NE
NE01899001OtherBCBS OF NE