Open MRI of Southern Illinois LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

OPEN MRI OF SOUTHERN ILLINOIS LLC

Doing business as

Imaging Center of Southern Illinois

Practice address

2016 Vadalabene Dr
Maryville, IL 62062-6901

Phone

(618) 288-4929

Fax

(618) 288-4531

NPI assigned

Sep 19, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Steven Michael McRae

Title

Managing Member

Phone

(618) 659-1167

Specialties & licenses 1

Addresses

Other names 1

• Imaging Center of Southern Illinois Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas B Doyle, MD

  • Diagnostic Radiology Physician
  • Breese, IL
  • NPI 1346206042
  NPD (past)
• Edward P Feutz, MD

  • Diagnostic Radiology Physician
  • Sparta, IL
  • NPI 1558326793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194710905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 868",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250868",
            "telephone_number": "618-659-1167",
            "fax_number": "618-659-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 VADALABENE DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620626901",
            "telephone_number": "618-288-4929",
            "fax_number": "618-288-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN MRI OF SOUTHERN ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCRAE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "618-659-1167",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imaging Center of Southern Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jean McGurk O'Brien, M.A., LCPC, NCC
• Katherine Ober
• Rebecca Erin Oberkrom, PA-C
• Boluwatife Olaoluwa Ojewande
• Jennifer Oliveira, CRNA
• Grace Ortiz, LCSW
• Jennifer Osaben
• Markel L Owens, M.D.
• Morgan Parker
• Ryan Parker, NP-C

• Radiology Clinic/Center in Maryville, IL
• Providers in Maryville, IL by specialty
• Radiology Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.