=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457357501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPENSIDED MRI OF NEW ORLEANS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2005
-----------------------------------------------------
Last Update Date | 01/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GALLERIA BLVD STE 715
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70001-7512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-837-6736
-----------------------------------------------------
Fax | 504-837-0835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 GALLERIA BLVD STE 715
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70001-7512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-749-6736
-----------------------------------------------------
Fax | 504-837-0835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER TREASURER
-----------------------------------------------------
Name | LINDA RHODES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-217-7114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471M1202X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 454551
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------