Healthcare Provider Details

I. General information

NPI: 1225028335
Provider Name (Legal Business Name): STADIUM OPEN MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PAYCOR STADIUM
CINCINNATI OH
45202-3418
US

IV. Provider business mailing address

6 PAYCOR STADIUM
CINCINNATI OH
45202-3418
US

V. Phone/Fax

Practice location:
  • Phone: 513-455-4999
  • Fax: 513-455-4998
Mailing address:
  • Phone: 513-455-4999
  • Fax: 513-455-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0677IC
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ALEXANDER BARBER
Title or Position: DIRECTOR, RCM
Credential:
Phone: 513-316-9385