Provider Demographics
NPI:1659773125
Name:OPEN MRI OF GRAND FORKS, LLC
Entity Type:Organization
Organization Name:OPEN MRI OF GRAND FORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:O
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:478-755-9966
Mailing Address - Street 1:2820 19TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5957
Mailing Address - Country:US
Mailing Address - Phone:478-755-9966
Mailing Address - Fax:478-755-9964
Practice Address - Street 1:2820 19TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5957
Practice Address - Country:US
Practice Address - Phone:478-755-9966
Practice Address - Fax:478-755-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)