Healthcare Provider Details

I. General information

NPI: 1225009731
Provider Name (Legal Business Name): NORTHLAND OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 NW BARRY RD SUITE 120
KANSAS CITY MO
64154-1465
US

IV. Provider business mailing address

PO BOX 450
NEW STANTON PA
15672-0450
US

V. Phone/Fax

Practice location:
  • Phone: 816-584-1674
  • Fax: 816-584-0442
Mailing address:
  • Phone: 724-925-2330
  • Fax: 724-925-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JACE D KELLER
Title or Position: TREASURER
Credential:
Phone: 724-925-2280