Provider Demographics
NPI:1760592752
Name:HOWARD OPEN MRI CENTER LLC
Entity Type:Organization
Organization Name:HOWARD OPEN MRI CENTER LLC
Other - Org Name:HOWARD OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SABINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-531-1900
Mailing Address - Street 1:6100 DAYLONG LN
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1626
Mailing Address - Country:US
Mailing Address - Phone:410-531-1900
Mailing Address - Fax:410-531-0484
Practice Address - Street 1:6100 DAYLONG LN
Practice Address - Street 2:SUITE 107
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1626
Practice Address - Country:US
Practice Address - Phone:410-531-1900
Practice Address - Fax:410-531-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM197261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMX003Medicare PIN