MEDICARE: OPEN 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	2085B0100X	Body Imaging Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DG2361	OTHER		MEDICARE RAILROAD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770550550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	PO BOX 950131
Second Line	:	DEPT 52629
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0131
Country	:	US
Telephone Number	:	502-429-6500
Fax Number	:	502-429-0770

Provider Business Practice Location Address
First Line	:	5227 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-1758
Country	:	US
Telephone Number	:	502-429-6500
Fax Number	:	502-429-0770

Authorized Official
Title or Position	:	CEO
Name	:	DR. EDWARD ROTHSCHILD
Credential	:	MD
Telephone Number	:	502-429-6500

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/24/2015

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Directions to “OPEN MRI, LLC ” Practice Location

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