Healthcare Provider Details

I. General information

NPI: 1114010873
Provider Name (Legal Business Name): IOWA OPEN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 6TH STREET SUITE 101
CORALVILLE IA
52241
US

IV. Provider business mailing address

PO BOX 1170 DEPT 5299
MILWAUKEE WI
53201-1170
US

V. Phone/Fax

Practice location:
  • Phone: 319-337-7458
  • Fax: 319-337-7510
Mailing address:
  • Phone: 219-793-9655
  • Fax: 219-793-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KIAYONA L TORRES
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 219-793-9655