Provider Demographics
NPI:1265457030
Name:OPEN MRI, LLC
Entity Type:Organization
Organization Name:OPEN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-314-7226
Mailing Address - Street 1:PO BOX 2819
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-2819
Mailing Address - Country:US
Mailing Address - Phone:228-314-7226
Mailing Address - Fax:228-314-7227
Practice Address - Street 1:14245 DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3369
Practice Address - Country:US
Practice Address - Phone:228-314-7226
Practice Address - Fax:228-314-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS10410Medicaid
1154338879OtherDIANNA RAGULA
MS16169Medicaid
MS03733573Medicaid
1831232479OtherDR RICHARD HAYS NPI
1144363771OtherDR WILLIAM HENRY NPI
MS03733573Medicaid
1154338879OtherDIANNA RAGULA
D66550Medicare UPIN
H28243Medicare UPIN