Organization
OPEN MRI OF COLES COUNTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNA D RUNGE PRESIDENT (PRESIDENT CEO)
(217) 345-0700
Entity
Organization
Contact information
Practice address
100 PROFESSIONAL PLAZA, STE 1A, MATTOON, IL 61938
(217) 345-0700
(217) 345-0712
Mailing address
100 PROFESSIONAL PLAZA, STE 1A, MATTOON, IL 61938
(217) 345-0700
(217) 345-0712
Taxonomy
Speciality
Code
Description
License number
State
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
Primary
33724466
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01532006
BLUE CROSS BLUE SHIELD
IL
01
—
081138
HMO HEALTH ALLIANCE
—
01
—
2924965
CIGNA
—
01
—
534801
HEALTHLINK PPO
—
Enumeration date
07/27/2006
Last updated
08/22/2020
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