Healthcare Provider Details

I. General information

NPI: 1235439191
Provider Name (Legal Business Name): KENNETT OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 RECOVERY RD
KENNETT MO
63857-3235
US

IV. Provider business mailing address

216 W MAIN ST STE A
STEELE MO
63877-1436
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-1320
  • Fax: 573-888-9704
Mailing address:
  • Phone: 573-695-2183
  • Fax: 573-695-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACEY L GALLAHER
Title or Position: BILLING
Credential:
Phone: 573-335-1779