Provider Demographics
NPI:1609811769
Name:OPENSIDED MRI OF LOUISVILLE, LLC
Entity Type:Organization
Organization Name:OPENSIDED MRI OF LOUISVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PLATUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-365-2220
Mailing Address - Street 1:2027 JEFFERSONVILLE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-282-0167
Mailing Address - Fax:812-282-3974
Practice Address - Street 1:2027 JEFFERSONVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-282-0167
Practice Address - Fax:812-282-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300024939Medicaid
IN247700OtherMEDICARE RAILROAD
IN100346500Medicaid