Provider Demographics
NPI:1558664565
Name:OPEN MRI AT EAGLE EYE RIVERSIDE, LLC
Entity type:Organization
Organization Name:OPEN MRI AT EAGLE EYE RIVERSIDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:IOELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-413-0979
Mailing Address - Street 1:PO BOX 2926
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-0926
Mailing Address - Country:US
Mailing Address - Phone:951-413-0979
Mailing Address - Fax:
Practice Address - Street 1:6276 RIVER CREST DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0783
Practice Address - Country:US
Practice Address - Phone:951-413-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)