Provider Demographics
NPI:1023061355
Name:MID-MICHIGAN MRI, INC.
Entity type:Organization
Organization Name:MID-MICHIGAN MRI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-364-3267
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:ROOM A202C
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7021
Mailing Address - Country:US
Mailing Address - Phone:517-355-3503
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2877
Practice Address - Fax:517-364-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N47620Medicare PIN
MI0P49440Medicare PIN