Healthcare Provider Details

I. General information

NPI: 1790720936
Provider Name (Legal Business Name): OPEN MRI OF MISSOURI, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD SUITE 111
SAINT LOUIS MO
63117-1223
US

IV. Provider business mailing address

100 PARAGON DR SUITE 200
MONTVALE NJ
07645-1779
US

V. Phone/Fax

Practice location:
  • Phone: 314-863-0084
  • Fax: 314-863-0096
Mailing address:
  • Phone: 201-573-8080
  • Fax: 201-775-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE M. BUCHWALTER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 201-573-8080