Provider Demographics
NPI:1225105018
Name:OPEN AIRE IMAGING CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:OPEN AIRE IMAGING CENTERS OF AMERICA LLC
Other - Org Name:OPEN AIRE MRI FT SMITH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:A SUE
Authorized Official - Middle Name:W
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-452-3810
Mailing Address - Street 1:5701 EUPER LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3237
Mailing Address - Country:US
Mailing Address - Phone:479-452-3910
Mailing Address - Fax:479-452-6553
Practice Address - Street 1:5701 EUPER LANE
Practice Address - Street 2:SUITE B
Practice Address - City:FT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3237
Practice Address - Country:US
Practice Address - Phone:479-452-3910
Practice Address - Fax:479-452-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142764002Medicaid
AR142764002Medicaid