Healthcare Provider Details

I. General information

NPI: 1811100407
Provider Name (Legal Business Name): ADVANCED OPEN MRI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 EAST MAIN STREET
OLNEY IL
62450
US

IV. Provider business mailing address

605 EAST MAIN STREET
OLNEY IL
62450
US

V. Phone/Fax

Practice location:
  • Phone: 618-392-6740
  • Fax: 618-395-3536
Mailing address:
  • Phone: 618-392-6740
  • Fax: 618-395-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number9258091
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHRISTOPHER J MILLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 618-395-7246