Provider Demographics
NPI:1710980511
Name:OPEN MRI OF FEDERAL WAY, L.L.C.
Entity Type:Organization
Organization Name:OPEN MRI OF FEDERAL WAY, L.L.C.
Other - Org Name:NYDIC OPEN MRI OF AMERICA-FEDERAL WAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUCHWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-573-8080
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1718
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-775-4306
Practice Address - Street 1:33301 9TH AVE S
Practice Address - Street 2:STE 105
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-2600
Practice Address - Country:US
Practice Address - Phone:253-952-8833
Practice Address - Fax:253-952-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA16-50184OtherUNITED HEALTHCARE
WA1069170OtherFIRST HEALTH NETWORK
WA115994OtherBWC
WA5574678OtherAETNA US HEALTHCARE
WA8922466OtherWA WC-CRIME VICTIMS
WAOP8664OtherREGENCE BS
WA115994OtherWASHINGTON WC
WA2504OtherMEDFOCUS
WA7085962Medicaid
WAA-70849OtherMULTIPLAN
WA=========OtherPREMERA BLUE CROSS
WAOP8664OtherREGENCE BS
WA115994OtherBWC