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General NPI Number Information
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NPI Number | 1114008000
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Entity Type | Organization
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Legal Business Name | PRAIRIE OPEN MRI, LLC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 01/01/2012
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Provider Practice Location Address
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Address Line | 2450 WOLF RD UNIT C
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City | WESTCHESTER
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State | IL
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Zip | 60154-5634
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Country | US
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Telephone | 708-409-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 E ROOSEVELT RD SUITE 5
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City | WHEATON
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State | IL
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Zip | 60187-6850
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Country | US
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Telephone | 877-444-4540
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | MR. EDWIN C SAGE
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Credential |
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Telephone | 877-444-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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