Provider Demographics
NPI:1568480028
Name:OPEN SYSTEM MRI 1 A CALIFORNIA LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:OPEN SYSTEM MRI 1 A CALIFORNIA LIMITED PARTNERSHIP
Other - Org Name:OPEN SYSTEM IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-346-6413
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-346-6413
Mailing Address - Fax:
Practice Address - Street 1:1401 N TUSTIN AVE
Practice Address - Street 2:170
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8644
Practice Address - Country:US
Practice Address - Phone:714-543-7643
Practice Address - Fax:714-480-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TD004OtherMEDICARE PTAN
TD004OtherMEDICARE PTAN