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General NPI Number Information
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NPI Number | 1659488161
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Entity Type | Organization
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Legal Business Name | JENNERSVILLE OPEN MRI AND IMAGING CENTER, LLC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 900 W BALTIMORE PIKE SUITE 102
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City | WEST GROVE
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State | PA
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Zip | 19390
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Country | US
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Telephone | 610-869-8889
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Fax | 610-869-7688
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Provider Business Mailing Address
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Address Line | 900 W BALTIMORE PIKE
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City | WEST GROVE
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State | PA
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Zip | 19390-9313
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Country | US
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Telephone | 610-869-8889
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Fax | 610-869-7688
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. JOHN ROLLINS
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Credential |
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Telephone | 610-869-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3688169
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License Number State | PA
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