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General NPI Number Information
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NPI Number | 1992826473
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Entity Type | Organization
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Legal Business Name | EASTLAND OPEN MRI LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 1505 EASTLAND DR LOWER LEVEL
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3534
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Country | US
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Telephone | 309-664-7788
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Fax | 309-665-0871
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Provider Business Mailing Address
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Address Line | 1505 EASTLAND DR. LOWER LEVEL
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City | BLOOMINGTON
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State | IL
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Zip | 61701
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Country | US
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Telephone | 309-664-7788
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Fax | 309-665-0871
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE A NORD
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Credential | MD
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Telephone | 309-664-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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