Provider Demographics
NPI:1689782344
Name:SILVERSIDE OPEN MRI AND IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:SILVERSIDE OPEN MRI AND IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:302-246-2000
Mailing Address - Street 1:2501 SILVERSIDE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3726
Mailing Address - Country:US
Mailing Address - Phone:302-246-2000
Mailing Address - Fax:302-246-2010
Practice Address - Street 1:2501 SILVERSIDE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3726
Practice Address - Country:US
Practice Address - Phone:302-246-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20062074792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEFDXVU2Medicare UPIN