Provider Demographics
NPI:1295763654
Name:OPEN MRI OF THE DESERT LTD
Entity type:Organization
Organization Name:OPEN MRI OF THE DESERT LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-346-6413
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1056
Mailing Address - Country:US
Mailing Address - Phone:760-346-6413
Mailing Address - Fax:760-568-9563
Practice Address - Street 1:44215 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2710
Practice Address - Country:US
Practice Address - Phone:760-346-6413
Practice Address - Fax:760-568-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ213742Medicare ID - Type Unspecified