# INDIANA OPEN MRI LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780655282
- **Authorized official:** MR. JACE D KELLER (TREASURER)
- **Authorized official phone:** (724) 925-2280

## Contact information

- **Practice address:** 1265 WAYNE AVE, SUITE 305, INDIANA, PA 15701-3501
- **Practice address phone:** (724) 349-3110
- **Practice address fax:** (724) 349-3149
- **Mailing address:** PO BOX 450, NEW STANTON, PA 15672-0450
- **Mailing address phone:** (724) 925-2330
- **Mailing address fax:** (724) 925-7816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | N/A | — | Yes |

## Other

- **Enumeration date:** 02/01/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1012169940001 | — | PA |
| 01 | — | 1689483 | HIGHMARK BCBS | PA |