Provider Demographics
NPI:1326007766
Name:PA OPEN MRI-HARRISBURG, PC
Entity Type:Organization
Organization Name:PA OPEN MRI-HARRISBURG, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-558-8300
Mailing Address - Street 1:5400D CHAMBERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2505
Mailing Address - Country:US
Mailing Address - Phone:717-558-8300
Mailing Address - Fax:717-561-8024
Practice Address - Street 1:5400D CHAMBERS HILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2505
Practice Address - Country:US
Practice Address - Phone:717-558-8300
Practice Address - Fax:717-561-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032855E207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016527750002Medicaid
PA959176Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #