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General NPI Number Information
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NPI Number | 1013931377
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF COLES COUNTY LLC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 PROFESSIONAL PLAZA STE 1A
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City | MATTOON
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State | IL
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Zip | 61938
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Country | US
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Telephone | 217-345-0700
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Fax | 217-345-0712
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Provider Business Mailing Address
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Address Line | 100 PROFESSIONAL PLAZA STE 1A
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City | MATTOON
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State | IL
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Zip | 61938
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Country | US
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Telephone | 217-345-0700
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Fax | 217-345-0712
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | SHANNA D RUNGE
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Credential | PRESIDENT
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Telephone | 217-345-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Internal Medicine Physician
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License Number | 33724466
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License Number State | IL
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