Provider Demographics
NPI:1942627567
Name:PURE OPEN MRI LLC
Entity Type:Organization
Organization Name:PURE OPEN MRI LLC
Other - Org Name:PURE OPEN MRI LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-430-5350
Mailing Address - Street 1:907 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3238
Mailing Address - Country:US
Mailing Address - Phone:248-298-3999
Mailing Address - Fax:248-298-5999
Practice Address - Street 1:907 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3238
Practice Address - Country:US
Practice Address - Phone:248-298-3999
Practice Address - Fax:248-298-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)