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NPI Code Detail

MEDICARE: OPENSIDED MRI OF LAS VEGAS, LLC

MEDICARE: OPENSIDED MRI OF LAS VEGAS, 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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962119941
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPENSIDED MRI OF LAS VEGAS, LLC
Provider Business Mailing Address
First Line : 600 S RANCHO DR STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4806
Country : US
Telephone Number : 702-932-2740
Fax Number : 702-932-2739
Provider Business Practice Location Address
First Line : 3175 SAINT ROSE PKWY STE 130
Second Line :
City : HENDERSON
State : NV
Zip : 89052-3507
Country : US
Telephone Number : 702-932-2740
Fax Number : 702-932-2739
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : JOHN STEVEN PLATUSIC
Credential :
Telephone Number : 804-363-1007
Provider Enumeration Date : 10/31/2022
Last Update Date : 10/31/2022

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