Provider Demographics
NPI:1447253257
Name:OPEN MRI OF DAVENPORT. L.L.C.
Entity type:Organization
Organization Name:OPEN MRI OF DAVENPORT. L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUCHWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-573-8080
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1718
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-775-4306
Practice Address - Street 1:3006 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3012
Practice Address - Country:US
Practice Address - Phone:563-359-5400
Practice Address - Fax:563-359-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7269100OtherCOVENTRY HEALTHCARE OF IA
IA47142OtherBCBS OF IOWA
IA1223691OtherFIRST HEALTH NETWORK
IA20446OtherMEDFOCUS
IA0180547Medicaid
IAA-87702OtherMULTIPLAN
IAF230734OtherMIDLANDS CHOICE
IA148415OtherIOWA HEALTH SOLUTIONS
IA47142OtherWELLMARK BCBS OF IOWA
IA7269100OtherCOVENTRY HEALTHCARE OF IA
IA=========001Medicaid
IA0180547Medicaid