Provider Demographics
NPI:1740283670
Name:OPEN MRI OF CLEVELAND, L.L.C.
Entity type:Organization
Organization Name:OPEN MRI OF CLEVELAND, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUCHWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-573-8080
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1718
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-775-4306
Practice Address - Street 1:3365 RICHMOND RD
Practice Address - Street 2:STE 100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4178
Practice Address - Country:US
Practice Address - Phone:216-292-9000
Practice Address - Fax:216-292-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0835-IC261QM1200X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPH06406187OtherNATIONWIDE HEALTH PLANS
OH175284OtherUNISON
OH3351OtherMEDFOCUS
OH5575697OtherAETNA
OH16-00667OtherUNITED HEALTHCARE OF OHIO
OH2433549Medicaid
OH000000168126OtherANTHEM BCBS
OH5575697OtherAETNA
OH=========-018OtherMEDICAL MUTUAL OF OHIO
OH2433549Medicaid