Provider Demographics
NPI:1902861750
Name:OPEN ADVANCED MRI OF PLAINFIELD, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF PLAINFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-609-4988
Mailing Address - Street 1:4714 CATON FARM RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8350
Mailing Address - Country:US
Mailing Address - Phone:815-609-4988
Mailing Address - Fax:815-609-4989
Practice Address - Street 1:4714 CATON FARM RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8350
Practice Address - Country:US
Practice Address - Phone:815-609-4988
Practice Address - Fax:815-609-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDB4311OtherRAILROAD MEDICARE
IL09932181OtherBLUE SHIELD
IL208404Medicare ID - Type UnspecifiedGROUP NUMBER