MEDICARE: OPEN MRI OF CINCINNATI, L.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		OH

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	:	1760485775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF CINCINNATI, L.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	:	201-505-8905

Provider Business Practice Location Address
First Line	:	2100 SHERMAN AVE
Second Line	:	STE 125
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2800
Country	:	US
Telephone Number	:	513-531-1100
Fax Number	:	513-531-1174

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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