Provider Demographics
NPI:1285630293
Name:SCHUYLKILL OPEN MRI INC
Entity Type:Organization
Organization Name:SCHUYLKILL OPEN MRI INC
Other - Org Name:OPEN MRI OF ALLENTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-6206
Mailing Address - Street 1:3550 LENOX RD NE STE 1525
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-4303
Mailing Address - Country:US
Mailing Address - Phone:470-552-8303
Mailing Address - Fax:
Practice Address - Street 1:48 TUNNEL RD STE 102
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-6206
Practice Address - Fax:570-622-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019476640004Medicaid
PA066759Medicare PIN
PA0019476640004Medicaid
P00029237Medicare PIN