MEDICARE: OPEN SYSTEM MRI 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1649718016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN SYSTEM MRI LLC.

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1056
Country	:	US
Telephone Number	:	760-346-6413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 SPRINGFIELD DR
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-6398
Country	:	US
Telephone Number	:	530-342-8121
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEN BISHOP
Credential	:
Telephone Number	:	760-346-6413

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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