Organization
OPEN MRI OF LAKE HAVASU LLC
Active
Organization
OPEN MRI OF LAKE HAVASU LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY R HARRIS (MANAGING MEMBER)
(256) 990-2629
Entity
Organization
Contact information
Practice address
2082 MESQUITE AVE, SUITE 114, LAKE HAVASU CITY, AZ 86403-6717
(928) 505-1511
(928) 505-1541
Mailing address
604B MADISON ST SE, HUNTSVILLE, AL 35801-4401
(256) 533-2311
(256) 533-2231
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OTC3930
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
089276
—
AZ
01
—
AZ0155710
BLUE CROSS
AZ
01
—
OTC3930
AZ DEPT OF HEALTH SVC
AZ
01
—
P00308294
MEDICARE RR PALMETTO GBA
AL
Enumeration date
04/25/2006
Last updated
02/22/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up