MEDICARE: OPEN MRI OF FORT WORTH, L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0726397	OTHER	TX	AMERIHEALTH
2	0026DC	OTHER	TX	BCBS OF TEXAS
3	825242	OTHER	TX	HEALTHSMART PREFERRED CAR
4	A-67817	OTHER	TX	MULTIPLAN
5	2030111	OTHER	TX	AETNA US HEALTHCARE
6	3650	OTHER	TX	MEDFOCUS
7	10013077	OTHER	TX	AMERIGROUP
8	16-14029	OTHER	TX	UNITED HEALTHCARE OF TX
9	25504	OTHER	TX	NYLCARE HEALTH PLANS

General Provider Information

NPI Number	:	1033112834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF FORT WORTH, L.C.

Provider Business Mailing Address
First Line	:	100 PARAGON DR
Second Line	:	STE 200
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1718
Country	:	US
Telephone Number	:	201-573-8080
Fax Number	:	201-775-4306

Provider Business Practice Location Address
First Line	:	6500 WEST FWY
Second Line	:	STE 104
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2139
Country	:	US
Telephone Number	:	817-763-5900
Fax Number	:	817-763-5858

Authorized Official
Title or Position	:	CEO
Name	:	LAWRENCE M. BUCHWALTER
Credential	:
Telephone Number	:	201-573-8080

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/11/2025

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