Provider Demographics
NPI:1790720936
Name:OPEN MRI OF MISSOURI, L.L.C.
Entity Type:Organization
Organization Name:OPEN MRI OF MISSOURI, L.L.C.
Other - Org Name:NYDIC OPEN MRI OF AMERICA-ST. LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
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:SUITE 200
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1779
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-775-4306
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1223
Practice Address - Country:US
Practice Address - Phone:314-863-0084
Practice Address - Fax:314-863-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
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
MO17064OtherMEDFOCUS
MOQMXPRO249467OtherALLIANCE BLUECHOICE
MO5052580OtherAETNA US HEALTHCARE
MO394937OtherHEALTHLINK
MO11159OtherHEALTHCARE USA
MO16-00435OtherUNITED HEALTHCARE OF MO
MO194356OtherBCBS OF MISSOURI
MO33820OtherGROUP HEALTH PLAN
MO33820OtherGROUP HEALTH PLAN