Provider Demographics
NPI:1962119941
Name:OPENSIDED MRI OF LAS VEGAS, LLC
Entity type:Organization
Organization Name:OPENSIDED MRI OF LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:PLATUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-363-1007
Mailing Address - Street 1:600 S RANCHO DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4806
Mailing Address - Country:US
Mailing Address - Phone:702-932-2740
Mailing Address - Fax:702-932-2739
Practice Address - Street 1:3175 SAINT ROSE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3507
Practice Address - Country:US
Practice Address - Phone:702-932-2740
Practice Address - Fax:702-932-2739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPENSIDED MRI OF LAS VEGAS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002702170Medicaid