Edmond MRI LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

EDMOND MRI LLC

Doing business as

Renaissance MRI

Practice address

1705 Renaissance Blvd
Suite 135
Edmond, OK 73013-3022

Phone

(580) 234-2878

NPI assigned

Mar 29, 2006

Organization subpart

No

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

Authorized official

Name

Philip Malone

Title

Operations Manager

Phone

(405) 321-8125

Specialties & licenses 1

Addresses

Other names 1

• Renaissance MRI Doing business as

Locations

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790746956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 RENAISSANCE BLVD",
            "address_2": "SUITE 135",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 RENAISSANCE BLVD",
            "address_2": "SUITE 135",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133022",
            "telephone_number": "580-234-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMOND MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "405-321-8125"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diagnostic Radiology Physician in Edmond, OK
• Providers in Edmond, OK by specialty
• Diagnostic Radiology Physician in Oklahoma

• 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.