Provider Demographics
NPI:1922190487
Name:OPEN MRI OF PUEBLO, LLC
Entity Type:Organization
Organization Name:OPEN MRI OF PUEBLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENBERRY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:813-284-2004
Mailing Address - Street 1:1425 B US HIGHWAY 50 WEST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1686
Mailing Address - Country:US
Mailing Address - Phone:719-404-0991
Mailing Address - Fax:719-404-0997
Practice Address - Street 1:1425 B US HIGHWAY 50 WEST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1686
Practice Address - Country:US
Practice Address - Phone:719-404-0991
Practice Address - Fax:719-404-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00116808OtherRR MEDICARE
CO81684339Medicaid
OP668242OtherBCBS
OP668242OtherBCBS
CO81684339Medicaid