Provider Demographics
NPI:1366501637
Name:MRI PHYSICIAN ASSOCIATES, PC
Entity Type:Organization
Organization Name:MRI PHYSICIAN ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CHECKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-464-8050
Mailing Address - Street 1:2451 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1031
Mailing Address - Country:US
Mailing Address - Phone:215-464-8050
Mailing Address - Fax:215-673-5767
Practice Address - Street 1:2451 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1031
Practice Address - Country:US
Practice Address - Phone:215-464-8050
Practice Address - Fax:215-673-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN1450OtherRAILROAD MEDICARE
PA0345430000OtherINDEPENDENCE BLUE CROSS
PA5123334OtherAETNA PPO
PA035757OtherHIGHMARK BLUE SHIELD
CN1450OtherRAILROAD MEDICARE