Healthcare Provider Details

I. General information

NPI: 1528190485
Provider Name (Legal Business Name): SOUTHEAST IOWA OPEN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN ST
BURLINGTON IA
52601-5012
US

IV. Provider business mailing address

600 N MAIN ST
BURLINGTON IA
52601-5012
US

V. Phone/Fax

Practice location:
  • Phone: 319-752-8282
  • Fax: 319-752-9005
Mailing address:
  • Phone: 319-752-8282
  • Fax: 319-752-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateIA

VIII. Authorized Official

Name: MELISSA K GRAHAM
Title or Position: BUSINESS OFFICE SUPERVISOR
Credential:
Phone: 319-752-8282