Organization
WIDE OPEN MRI OF BULLHEAD CITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON A CYRUS (OWNER)
(928) 704-0080
Entity
Organization
Contact information
Practice address
2000 HIGHWAY 95, SUITE 222, BULLHEAD CITY, AZ 86442-6050
(928) 704-0080
(928) 704-1654
Mailing address
2000 HIGHWAY 95, SUITE 222, BULLHEAD CITY, AZ 86442-6050
(928) 704-0080
(928) 704-1654
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
912776
—
AZ
01
—
AZ0769960
BLUE CROSS
AZ
Enumeration date
06/22/2006
Last updated
06/07/2011
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