Provider Demographics
NPI:1376598292
Name:JEFFERSON CITY OPEN MRI LLC
Entity Type:Organization
Organization Name:JEFFERSON CITY OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-496-5185
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74013-0366
Mailing Address - Country:US
Mailing Address - Phone:888-922-2299
Mailing Address - Fax:
Practice Address - Street 1:3218 W EDGEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6951
Practice Address - Country:US
Practice Address - Phone:573-635-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00117646Medicare PIN
MO000047016Medicare ID - Type Unspecified