Provider Demographics
NPI:1598720336
Name:OPEN ADVANCED MRI OF TINLEY PARK, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF TINLEY PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-444-2101
Mailing Address - Street 1:7711 159TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1329
Mailing Address - Country:US
Mailing Address - Phone:708-444-2101
Mailing Address - Fax:708-444-2102
Practice Address - Street 1:7711 159TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1329
Practice Address - Country:US
Practice Address - Phone:708-444-2101
Practice Address - Fax:708-444-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCJ8757OtherRAILROAD MEDICARE
IL01632306OtherBLUE SHIELD
ILCJ8757OtherRAILROAD MEDICARE