Provider Demographics
NPI:1508315086
Name:DECATUR OPEN MRI, INC.
Entity Type:Organization
Organization Name:DECATUR OPEN MRI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:KEFALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-520-2262
Mailing Address - Street 1:2905 N MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4276
Mailing Address - Country:US
Mailing Address - Phone:217-330-6930
Mailing Address - Fax:217-791-6906
Practice Address - Street 1:2905 N MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4276
Practice Address - Country:US
Practice Address - Phone:217-330-6930
Practice Address - Fax:217-791-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)