Provider Demographics
NPI:1831143015
Name:SIOUX FALLS OPEN MRI, LLC
Entity type:Organization
Organization Name:SIOUX FALLS OPEN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-689-1000
Mailing Address - Street 1:111 RAINBOW ST
Mailing Address - Street 2:PO BOX 1019
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4703
Mailing Address - Country:US
Mailing Address - Phone:605-689-1000
Mailing Address - Fax:
Practice Address - Street 1:6001 S SHARON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5746
Practice Address - Country:US
Practice Address - Phone:605-332-5743
Practice Address - Fax:605-332-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD39552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS8182Medicare PIN