Provider Demographics
NPI:1598886251
Name:WINCHESTER OPEN MRI
Entity Type:Organization
Organization Name:WINCHESTER OPEN MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DINEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-737-2783
Mailing Address - Street 1:PO BOX 1896
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-1896
Mailing Address - Country:US
Mailing Address - Phone:859-626-0484
Mailing Address - Fax:
Practice Address - Street 1:475 SHOPPERS VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-737-2783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277981Medicaid
KY64277981Medicaid
KY7336Medicare ID - Type Unspecified