Provider Demographics
NPI:1841288735
Name:CAMBRIDGE OPEN MRI
Entity type:Organization
Organization Name:CAMBRIDGE OPEN MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHLOVECHOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-435-8980
Mailing Address - Street 1:216 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2528
Mailing Address - Country:US
Mailing Address - Phone:740-435-8980
Mailing Address - Fax:740-435-8987
Practice Address - Street 1:216 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2528
Practice Address - Country:US
Practice Address - Phone:740-435-8980
Practice Address - Fax:740-435-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355295Medicaid
OHX78631Medicare UPIN
OH2355295Medicaid