Healthcare Provider Details

I. General information

NPI: 1043279839
Provider Name (Legal Business Name): MIDWEST OPEN MRI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17020 E 40 HWY #4
INDEPENDENCE MO
64055-5361
US

IV. Provider business mailing address

PO BOX 413022
KANSAS CITY MO
64141-3022
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4422
  • Fax: 816-478-7773
Mailing address:
  • Phone: 913-234-1494
  • Fax: 913-234-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HENLEY III
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 816-478-4422