Provider Demographics
NPI:1619213949
Name:WEST MICHIGAN IMAGING PARTNERS LLC
Entity Type:Organization
Organization Name:WEST MICHIGAN IMAGING PARTNERS LLC
Other - Org Name:OPEN MRI OF GRAND RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-889-4580
Mailing Address - Street 1:3949 SPARKS DR SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3949 SPARKS DR SE
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6110
Practice Address - Country:US
Practice Address - Phone:248-229-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)