Provider Demographics
NPI:1912929126
Name:OPEN M.R.I OF CHESTNUT HILL, L.L.C.
Entity Type:Organization
Organization Name:OPEN M.R.I OF CHESTNUT HILL, L.L.C.
Other - Org Name:CHESTNUT HILL OPEN M.R.I.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-248-1200
Mailing Address - Street 1:7713 CRITTENDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118
Mailing Address - Country:US
Mailing Address - Phone:215-248-1200
Mailing Address - Fax:215-248-5070
Practice Address - Street 1:7713 CRITTENDEN STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-4407
Practice Address - Country:US
Practice Address - Phone:215-248-1200
Practice Address - Fax:215-248-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067372Medicare ID - Type Unspecified