Healthcare Provider Details

I. General information

NPI: 1942627567
Provider Name (Legal Business Name): PURE OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 S MAIN ST SUITE B
ROYAL OAK MI
48067-3238
US

IV. Provider business mailing address

907 S MAIN ST SUITE B
ROYAL OAK MI
48067-3238
US

V. Phone/Fax

Practice location:
  • Phone: 248-298-3999
  • Fax: 248-298-5999
Mailing address:
  • Phone: 248-298-3999
  • Fax: 248-298-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH ROUNDING
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 248-430-5350