Provider Demographics
NPI:1225028335
Name:STADIUM OPEN MRI, LLC
Entity Type:Organization
Organization Name:STADIUM OPEN MRI, LLC
Other - Org Name:PROSCAN IMAGING SIX PAUL BROWN STADIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RCM
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-316-9385
Mailing Address - Street 1:6 PAUL BROWN STADIUM
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-3418
Mailing Address - Country:US
Mailing Address - Phone:513-455-4999
Mailing Address - Fax:513-455-4998
Practice Address - Street 1:6 PAYCOR STADIUM
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-3418
Practice Address - Country:US
Practice Address - Phone:513-455-4999
Practice Address - Fax:513-455-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0677IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2228888Medicaid
IN200473300AMedicaid
KY86000585Medicaid
OH000000332753OtherANTHEM PIN
OHID02151Medicare PIN