MEDICARE: OPEN AIRE IMAGING CENTERS OF AMERICA 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225105018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN AIRE IMAGING CENTERS OF AMERICA LLC

Provider Business Mailing Address
First Line	:	5701 EUPER LANE
Second Line	:	SUITE B
City	:	FT SMITH
State	:	AR
Zip	:	72903-3237
Country	:	US
Telephone Number	:	479-452-3910
Fax Number	:	479-452-6553

Provider Business Practice Location Address
First Line	:	5701 EUPER LANE
Second Line	:	SUITE B
City	:	FT SMITH
State	:	AR
Zip	:	72903-3237
Country	:	US
Telephone Number	:	479-452-3910
Fax Number	:	479-452-6553

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. A SUE W REEVES
Credential	:
Telephone Number	:	479-452-3810

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	04/06/2015

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