Provider Demographics
NPI:1013931377
Name:OPEN MRI OF COLES COUNTY LLC
Entity Type:Organization
Organization Name:OPEN MRI OF COLES COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:217-345-0700
Mailing Address - Street 1:100 PROFESSIONAL PLAZA
Mailing Address - Street 2:STE 1A
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938
Mailing Address - Country:US
Mailing Address - Phone:217-345-0700
Mailing Address - Fax:217-345-0712
Practice Address - Street 1:100 PROFESSIONAL PLAZA
Practice Address - Street 2:STE 1A
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938
Practice Address - Country:US
Practice Address - Phone:217-345-0700
Practice Address - Fax:217-345-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33724466207RM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2924965OtherCIGNA
081138OtherHMO HEALTH ALLIANCE
534801OtherHEALTHLINK PPO
IL01532006OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL=========001Medicaid