Healthcare Provider Details

I. General information

NPI: 1205857232
Provider Name (Legal Business Name): OPEN SIDED MRI OF LAS VEGAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/08/2021
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S RANCHO DR STE 101
LAS VEGAS NV
89106-4806
US

IV. Provider business mailing address

600 S RANCHO DR STE 101
LAS VEGAS NV
89106-4806
US

V. Phone/Fax

Practice location:
  • Phone: 702-932-2740
  • Fax: 702-932-2739
Mailing address:
  • Phone: 702-932-2740
  • Fax: 702-932-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberNV19961017227
License Number StateNV

VIII. Authorized Official

Name: JOHN STEVEN PLATUSIC
Title or Position: COO
Credential:
Phone: 804-363-1007