Healthcare Provider Details

I. General information

NPI: 1457343204
Provider Name (Legal Business Name): PREMIER OPEN MRI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAIN ST
WICHITA KS
67202-3722
US

IV. Provider business mailing address

500 S MAIN ST
WICHITA KS
67202-3722
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-1103
  • Fax: 316-262-1203
Mailing address:
  • Phone: 316-262-1103
  • Fax: 316-262-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONI COOPER
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 754-206-6198