PREFERRED OPEN MRI, LTD. , NPI 1205888351 — CHICAGO (IL)

NPI 1205888351

13+ Years Experience Organization

PREFERRED OPEN MRI, LTD.

05/17/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1205888351
NPI NUMBER

About PREFERRED OPEN MRI, LTD.

PREFERRED OPEN MRI, LTD. is a provider established in CHICAGO, IL. The NPI number of PREFERRED OPEN MRI, LTD. is 1205888351 and was assigned on 05/17/2006. The practitioners primary taxonomy code is: 2471B0102X .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606295010
  • Phone: 7735815600
  • Fax: 7735815608
  • Address: 4200 W 63RD ST

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1205888351
  • Phone : 7735815600
  • Fax : 7735815608
  • Postalcode : 606295010
  • Address : 4200 W 63RD ST

Additional identifiers

  • Identifier: 1632652
  • Code / Type : 1 - other
  • Identifier state : IL
  • Identifier issuer: BCBS OF ILL PROVIDER NUMB

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Radiologic Technologist

  • Taxonomy code: 2471B0102X

The primary taxonomy switch is Not Answered.

Taxonomy group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP.

Healthcare provider taxonomy #2 - Radiologic Technologist

  • Taxonomy code: 2471C3401X

The primary taxonomy switch is Not Answered.

Contacts:

Click to Show Map
  • PREFERRED OPEN MRI, LTD.
  • Address : 4200 W 63RD ST
  • Region : CHICAGO, IL
  • NPI : 1205888351
  • Phone : 7735815600
  • Fax : 7735815608
  • Postalcode : 606295010

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 7735815600
  • Title or position : PRESIDENT

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4200 W 63RD ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606295010
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7735815600
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7735815608
The fax number associated with the location address of the provider being identified.
NPI1205888351
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12471B0102X
Provider Enumeration Date05/17/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)PREFERRED OPEN MRI, LTD.
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address4200 W 63RD ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606295010
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7735815600
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7735815608
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameRUSTOM
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameNASER
The first name of the authorized official
Authorized Official Title or PositionPRESIDENT
The title or position of the authorized official
Authorized Official Name Prefix TextMR.
Authorized Official Name Prefix Text
Authorized Official Telephone Number7735815600
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #12471B0102X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiologic Technologist
Healthcare Provider Primary Taxonomy Switch 1X
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 22471C3401X
Healthcare Provider Taxonomy 2Radiologic Technologist
Healthcare Provider Primary Taxonomy Switch 2X
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11632652
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1IL
Other Provider Identifier State #1
Other Provider Identifier Issuer 1BCBS OF ILL PROVIDER NUMB
Other Provider Identifier Issuer #1
X

Share this page?