Organization
OPEN AND WIDE MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARDNER BARTROM (PRESIDENT)
(765) 228-4660
Entity
Organization
Contact information
Practice address
3050 WINDSOR COURT, ELKHART, IN 46514-5555
(574) 266-9222
Mailing address
PO BOX 338, LA FONTAINE, IN 46940-0338
(765) 228-4660
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200415560
—
IN
01
—
CK6657
RAILROAD MEDICARE
IN
Enumeration date
06/02/2006
Last updated
01/08/2024
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