Provider Demographics
NPI:1982643326
Name:MAPLE CREST OPEN MRI
Entity Type:Organization
Organization Name:MAPLE CREST OPEN MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-268-4019
Mailing Address - Street 1:840 W KANSAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2033
Mailing Address - Country:US
Mailing Address - Phone:816-781-9797
Mailing Address - Fax:816-781-9793
Practice Address - Street 1:840 W KANSAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2033
Practice Address - Country:US
Practice Address - Phone:816-781-9797
Practice Address - Fax:816-781-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34425017OtherBLUE CROSS BLUE SHIELD
MO9004220Medicare ID - Type Unspecified