Healthcare Provider Details

I. General information

NPI: 1598938862
Provider Name (Legal Business Name): OPEN MRI DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 E WESTVIEW CT #A
SPOKANE WA
99218-1384
US

IV. Provider business mailing address

1116 E WESTVIEW CT #A
SPOKANE WA
99218-1384
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-6736
  • Fax: 509-455-6737
Mailing address:
  • Phone: 509-455-6736
  • Fax: 509-455-6737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00026919
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License NumberMD00026919
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD00026919
License Number StateWA

VIII. Authorized Official

Name: RENEA DEHN
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-464-7840