NPIMap

Organization Active NPI

Miracor Diagnostics, Inc.

Doing business as Wide Open MRI

  • Physiological Laboratory
  • Long Beach, CA
National Provider Identifier
1205943636
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MIRACOR DIAGNOSTICS, INC.
Doing business as
Wide Open MRI
Practice address
3715 E South St
Long Beach, CA 90805-4521
Phone
(562) 602-0700
Fax
(562) 602-0727
NPI assigned
Aug 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gaelane Rosinski
Title
Contracting/Credentialing Specialis
Phone
(847) 658-0996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X CA Primary

Addresses

Primary practice location

3715 E South St
Long Beach, CA 90805-4521

Mailing address

3715 E South St
Long Beach, CA 90805-4521
Phone (562) 602-0700

Other names 1

  • Wide Open MRI Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Miracor Diagnostics Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205943636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 E SOUTH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908054521",
            "telephone_number": "562-602-0700",
            "fax_number": "562-602-0727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 E SOUTH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908054521",
            "telephone_number": "562-602-0700",
            "fax_number": "562-602-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACOR DIAGNOSTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROSINSKI",
        "authorized_official_first_name": "GAELANE",
        "authorized_official_title_or_position": "CONTRACTING/CREDENTIALING SPECIALIS",
        "authorized_official_telephone_number": "847-658-0996"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wide Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • 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.