Provider Demographics
NPI:1598702870
Name:OPEN MRI & IMAGING CENTER OF ELKTON,LLC
Entity Type:Organization
Organization Name:OPEN MRI & IMAGING CENTER OF ELKTON,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-398-4000
Mailing Address - Street 1:PO BOX 7422
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-7422
Mailing Address - Country:US
Mailing Address - Phone:410-398-3868
Mailing Address - Fax:
Practice Address - Street 1:301 AUGUSTINE HERMAN HWY
Practice Address - Street 2:STE A
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6587
Practice Address - Country:US
Practice Address - Phone:410-620-1900
Practice Address - Fax:410-620-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X, 261QM1300X
MDM292261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408729100Medicaid
MDFMXUV1Medicare PIN
MD408729100Medicaid