Provider Demographics
NPI:1548281264
Name:NIAGARA FALLS OPEN MRI,LLC
Entity type:Organization
Organization Name:NIAGARA FALLS OPEN MRI,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:CARDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-437-8330
Mailing Address - Street 1:22710 EXECUTIVE DR
Mailing Address - Street 2:OPEN MRI OF NIAGARA FALLS, LLC
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166
Mailing Address - Country:US
Mailing Address - Phone:703-464-0318
Mailing Address - Fax:703-464-0319
Practice Address - Street 1:4519 MILITARY ROAD
Practice Address - Street 2:OPEN MRI OF NIAGARA FALLS, LLC
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305
Practice Address - Country:US
Practice Address - Phone:716-298-9362
Practice Address - Fax:716-298-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0768Medicare UPIN