Open MRI of Lake Havasu LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

OTC3930 Issued in AZ

Legal business name

OPEN MRI OF LAKE HAVASU LLC

Practice address

2082 Mesquite Ave
Suite 114
Lake Havasu City, AZ 86403-6717

Phone

(928) 505-1511

Fax

(928) 505-1541

NPI assigned

Apr 25, 2006

Organization subpart

No

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

Authorized official

Name

Tommy R Harris

Title

Managing Member

Phone

(256) 990-2629

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1669438867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604B MADISON ST SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014401",
            "telephone_number": "256-533-2311",
            "fax_number": "256-533-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2082 MESQUITE AVE",
            "address_2": "SUITE 114",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036717",
            "telephone_number": "928-505-1511",
            "fax_number": "928-505-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN MRI OF LAKE HAVASU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "256-990-2629"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "OTC3930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "089276",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ DEPT OF HEALTH SVC",
            "identifier": "OTC3930",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "AZ0155710",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PALMETTO GBA",
            "identifier": "P00308294",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Ann Olsavsky, SLPA
• One Bridge Surgical, PLLC
• One Touch Med Alert LLC
• Jonathan K Oneill, PT, DPT
• Angelo Ong-Veloso Jr., M.D.
• Ramon R Orduno Jr., CRNA
• Kaitlyn April Ornelas
• William S Orr, D.C.
• Eugenia Osbon
• Vic S Oyas, M.D.

• Diagnostic Radiology Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Diagnostic Radiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; 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.