Provider Demographics
NPI:1205824679
Name:OPEN MR INC.
Entity Type:Organization
Organization Name:OPEN MR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:VOLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-668-3505
Mailing Address - Street 1:301 CITY AVENUE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1708
Mailing Address - Country:US
Mailing Address - Phone:610-668-3505
Mailing Address - Fax:610-668-3509
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-668-3505
Practice Address - Fax:610-668-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001415860001Medicaid
PA001415860001Medicaid
PA745948Medicare PIN