MEDICARE: OPEN MRI INC

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	293D00000X	Physiological Laboratory

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

General Provider Information

NPI Number	:	1114984382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI INC

Provider Business Mailing Address
First Line	:	FILE 57174
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-0001
Country	:	US
Telephone Number	:	949-282-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 S BRISTOL ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5727
Country	:	US
Telephone Number	:	714-966-0904
Fax Number	:	714-966-0972

Authorized Official
Title or Position	:	SENIOR V.P. & CHIEF ACCOUNTING OFCR
Name	:	MR. BRIAN G DRAZBA
Credential	:
Telephone Number	:	949-282-6000

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	11/16/2007

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