Provider Demographics
NPI:1669473591
Name:AROOSTOOK MRI, LLC
Entity Type:Organization
Organization Name:AROOSTOOK MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGMORE-GRUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:100 BAYVIEW CIRCLE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2984
Mailing Address - Country:US
Mailing Address - Phone:949-242-5592
Mailing Address - Fax:602-773-3622
Practice Address - Street 1:140 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:800-646-6121
Practice Address - Fax:888-603-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1076154261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME172770000Medicaid
ME172770000Medicaid