MEDICARE: OPEN IMAGING-LAYTON, LLC

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1174526107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN IMAGING-LAYTON, LLC

Provider Business Mailing Address
First Line	:	PO BOX 641825
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45264-1825
Country	:	US
Telephone Number	:	888-674-7933
Fax Number	:	952-513-6880

Provider Business Practice Location Address
First Line	:	2071 N MAIN ST STE 100
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4970
Country	:	US
Telephone Number	:	801-825-4040
Fax Number	:	801-825-4039

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	ALBERT C. VAN KIRK
Credential	:
Telephone Number	:	330-653-3968

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/23/2021

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