MEDICARE: OPEN MRI OF MISSOURI, 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
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17064	OTHER	MO	MEDFOCUS
2	QMXPRO249467	OTHER	MO	ALLIANCE BLUECHOICE
3	5052580	OTHER	MO	AETNA US HEALTHCARE
4	394937	OTHER	MO	HEALTHLINK
5	11159	OTHER	MO	HEALTHCARE USA
6	16-00435	OTHER	MO	UNITED HEALTHCARE OF MO
7	194356	OTHER	MO	BCBS OF MISSOURI
8	33820	OTHER	MO	GROUP HEALTH PLAN

General Provider Information

NPI Number	:	1790720936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF MISSOURI, L.L.C.

Provider Business Mailing Address
First Line	:	100 PARAGON DR
Second Line	:	SUITE 200
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1779
Country	:	US
Telephone Number	:	201-573-8080
Fax Number	:	201-775-4306

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 111
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-863-0084
Fax Number	:	314-863-0096

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	09/11/2025

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