Provider Demographics
NPI:1952358699
Name:OPEN MRI OF OMAHA LLC
Entity Type:Organization
Organization Name:OPEN MRI OF OMAHA LLC
Other - Org Name:NYDIC OPEN MRI OF AMERICA-OMAHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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:SUITE 200
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1779
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-775-4306
Practice Address - Street 1:310 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3791
Practice Address - Country:US
Practice Address - Phone:402-391-1600
Practice Address - Fax:402-391-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03701OtherBCBS OF NEBRASKA
IA0511881Medicaid
NE1600173OtherUNITED HEALTHCARE
IA96860OtherWELLMARK OF IOWA
NE=========13Medicaid
NE098987Medicare ID - Type UnspecifiedIDTF