Organization
INDIANA OPEN MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACE D KELLER (TREASURER)
(724) 925-2280
Entity
Organization
Contact information
Practice address
1265 WAYNE AVE, SUITE 305, INDIANA, PA 15701-3501
(724) 349-3110
(724) 349-3149
Mailing address
PO BOX 450, NEW STANTON, PA 15672-0450
(724) 925-2330
(724) 925-7816
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012169940001
—
PA
01
—
1689483
HIGHMARK BCBS
PA
Enumeration date
02/01/2006
Last updated
08/22/2020
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