OPEN MRI OF LAKE HAVASU LLC (NPI# 1669438867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669438867 |
| Entity Type | Organization |
| Organization Name | OPEN MRI OF LAKE HAVASU LLC |
| Practice Address |
2082 Mesquite Ave Suite 114 Lake Havasu City AZ 86403-6717 |
| Mailing Address |
604b Madison St Se Huntsville AL 35801-4401 |
| Practice Telephone | 9285051511 |
| Practice Fax Number | 9285051541 |
| Mailing Telephone | 2565332311 |
| Mailing Fax Number | 2565332231 |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-02-22 |
| Authorized Official Name | TOMMY R HARRIS (MANAGING MEMBER) |
| Authorized Official Telephone | 2569902629 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
OTC3930 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AZ DEPT OF HEALTH SVC | OTC3930 | 01 |
| AL | MEDICARE RR PALMETTO GBA | P00308294 | 01 |
| AZ | 089276 | 05 | |
| AZ | BLUE CROSS | AZ0155710 | 01 |
| Street Address |
2082 MESQUITE AVE SUITE 114 |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-6717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700864436 | Elizabeth Anne Smith-tryon | Internal Medicine | 2082 Mesquite Ave, Ste 106, Lake Havasu City, AZ 86403-6710 | 2006-01-03 |
| 1790253318 | Cardiovascular and Thoracic Solutions | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2082 Mesquite Ave, Lake Havasu City, AZ 86403-6710 | 2018-11-13 |
| 1861905416 | Kasey Cox | Nurse Practitioner | 2082 Mesquite Ave, Lake Havasu City, AZ 86403-6710 | 2017-11-06 |
| 1982123618 | Paul Andrew Mahnke | Nurse Practitioner | 2082 Mesquite Ave, Lake Havasu City, AZ 86403-6710 | 2017-09-13 |
| 1669729851 | Weiss Pediatrics Pllc | Pediatrics | 2082 Mesquite Ave, Suite A-102, Lake Havasu City, AZ 86403-6710 | 2012-08-07 |
| 1881941169 | Cornerstone Family Healthcare | Internal Medicine | 2082 Mesquite Ave, Suite 106, Lake Havasu City, AZ 86403-6710 | 2012-08-06 |
| 1104102482 | Sego Medical Associates LLC | Internal Medicine | 2082 Mesquite Ave, Suite 106, Lake Havasu City, AZ 86403-6710 | 2011-10-31 |
| 1790088250 | Shirley Noronha Md LLC | Internal Medicine | 2082 Mesquite Ave, Suite106, Lake Havasu City, AZ 86403-6710 | 2010-12-06 |
| 1548426489 | Arizona Family Medicine PC | Family Medicine | 2082 Mesquite Ave, Suite A106, Lake Havasu City, AZ 86403-6710 | 2008-07-30 |
| 1851553119 | Fadi Atassi | Internal Medicine | 2082 Mesquite Ave, Suite A100, Lake Havasu City, AZ 86403-6710 | 2008-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972825644 | Havasu Regional Medical Center LLC | Radiology | 1799 Kiowa Ave, # 104, Lake Havasu City, AZ 86403-2881 | 2010-02-23 |
| 1972657633 | Daniel Rawn Emig | Radiology | 3662 N Winifred Way, Lake Havasu City, AZ 86404-5959 | 2007-01-22 |
| 1528003233 | Radiological Services of Northern Arizona, PC | Radiology | 1944 Mesquite Ave, Lake Havasu City, AZ 86403-5729 | 2006-06-17 |
| 1598750820 | Jack D Dunn | Radiology | 2130 Mesquite Ave Unit 108, Lake Havasu City, AZ 86403-6897 | 2005-09-13 |
| 1497264873 | Pinnacle Radiology Services | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-28 |
| 1316275290 | Peter M. Mamalakis | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2009-12-03 |
| 1104064997 | Arizona Coast Radiology, Pllc | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2009-02-02 |
| 1952592339 | Lake Havasu Radiology, Pllc | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2007-08-09 |
| 1609808153 | Ayman Nicholas Awad | Radiology | 1944 Mesquite Ave, Lake Havasu City, AZ 86403-5729 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295345783 | Susan Shotts | Radiology | 861 N Higley Rd Ste B101, Gilbert, AZ 85234-9602 | 2020-08-09 |
| 1841840188 | Smsj Imaging Company LLC | Radiology | 630 N Alvernon Way Ste 150, Tucson, AZ 85711-1844 | 2019-09-18 |
| 1417507765 | Smsj Imaging Company LLC | Radiology | 395 N Silverbell Rd Ste 185, Tucson, AZ 85745-2721 | 2019-09-18 |
| 1154971497 | Smsj Imaging Company LLC | Radiology | 400 W Camino Casa Verde Ste 200, Green Valley, AZ 85614-3569 | 2019-09-18 |
| 1740839786 | Smsj Imaging Company LLC | Radiology | 4892 N Stone Ave Ste 180, Tucson, AZ 85704-5761 | 2019-09-11 |
| 1689239824 | Thumb Butte Radiology, LLC | Radiology | 3120 Willow Creek Rd, Prescott, AZ 86301-6699 | 2019-05-02 |
| 1376017020 | Vpa PC | Radiology | 64 E Broadway Rd Ste 200231, Tempe, AZ 85282-1353 | 2019-01-16 |
| 1598243867 | Mdig of Florida, LLC | Radiology | 10835 N 25th Ave Ste 140, Phoenix, AZ 85029-3408 | 2018-07-30 |
| 1689182966 | Faca Vascular | Radiology | 1831 E Queen Creek Rd Ste 120, Chandler, AZ 85286-2019 | 2018-01-20 |
| 1265974836 | Teleradiology Specialists LLC | Radiology | 4813 E Piccadilly Rd, Phoenix, AZ 85018-5540 | 2016-11-13 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.