Provider Demographics
NPI:1235439191
Name:KENNETT OPEN MRI LLC
Entity type:Organization
Organization Name:KENNETT OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-1779
Mailing Address - Street 1:216 W MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:STEELE
Mailing Address - State:MO
Mailing Address - Zip Code:63877-1436
Mailing Address - Country:US
Mailing Address - Phone:573-695-2183
Mailing Address - Fax:573-695-2796
Practice Address - Street 1:402 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3235
Practice Address - Country:US
Practice Address - Phone:573-888-1320
Practice Address - Fax:573-888-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)