Provider Demographics
NPI:1831290121
Name:TRI CITIES OPEN MRI LLC
Entity Type:Organization
Organization Name:TRI CITIES OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:630-444-0082
Mailing Address - Street 1:40W222 LAFOX RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7625
Mailing Address - Country:US
Mailing Address - Phone:630-444-0082
Mailing Address - Fax:630-444-0083
Practice Address - Street 1:40W222 LAFOX RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7625
Practice Address - Country:US
Practice Address - Phone:630-444-0082
Practice Address - Fax:630-444-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210875Medicare ID - Type Unspecified