Provider Demographics
NPI:1689611303
Name:MIDWEST OPEN MRI, LLC
Entity Type:Organization
Organization Name:MIDWEST OPEN MRI, LLC
Other - Org Name:MIDWEST OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:OREB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-6146
Mailing Address - Street 1:1044 SW 44TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3609
Mailing Address - Country:US
Mailing Address - Phone:405-631-4263
Mailing Address - Fax:405-631-4820
Practice Address - Street 1:2300 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-7114
Practice Address - Country:US
Practice Address - Phone:405-736-9222
Practice Address - Fax:405-736-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN/A261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)