Provider Demographics
NPI:1922147586
Name:ENVISION OPEN MRI LLC
Entity Type:Organization
Organization Name:ENVISION OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRANZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-325-8415
Mailing Address - Street 1:301 N 44TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3707
Mailing Address - Country:US
Mailing Address - Phone:402-467-5335
Mailing Address - Fax:
Practice Address - Street 1:1414 AVENUE J
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-1167
Practice Address - Country:US
Practice Address - Phone:712-325-8415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE184562471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE42127426313Medicaid
IAF74960Medicare UPIN
NE42127426313Medicaid