MEDICARE: OPEN MRI OF WASHINGTON COUNTY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	N/A

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1563981	OTHER	PA	HIGHMARK BCBS

General Provider Information

NPI Number	:	1043257207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF WASHINGTON COUNTY LLC

Provider Business Mailing Address
First Line	:	PO BOX 450
Second Line	:
City	:	NEW STANTON
State	:	PA
Zip	:	15672-0450
Country	:	US
Telephone Number	:	724-925-2330
Fax Number	:	724-925-7816

Provider Business Practice Location Address
First Line	:	4165 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-941-7900
Fax Number	:	724-941-3233

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. JACE D KELLER
Credential	:
Telephone Number	:	724-925-2280

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/22/2020

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