OPEN MRI OF SOUTHERN ILLINOIS LLC (NPI# 1194710905) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194710905 |
| Entity Type | Organization |
| Organization Name | OPEN MRI OF SOUTHERN ILLINOIS LLC |
| Other Organization Name | IMAGING CENTER OF SOUTHERN ILLINOIS |
| Practice Address |
2016 Vadalabene Dr Maryville IL 62062-6901 |
| Mailing Address |
Po Box 868 Edwardsville IL 62025-0868 |
| Practice Telephone | 6182884929 |
| Practice Fax Number | 6182884531 |
| Mailing Telephone | 6186591167 |
| Mailing Fax Number | 6186591197 |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. STEVEN MICHAEL MCRAE (MANAGING MEMBER) |
| Authorized Official Telephone | 6186591167 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Imaging Center of Southern Illinois | Doing Business As Name - Organization |
| Street Address |
2016 VADALABENE DR |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-6901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255805594 | Sara Marie Grotefendt | Nurse Practitioner | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2019-01-21 |
| 1356857171 | Maryville Womens Center PC | Obstetrics & Gynecology | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2017-12-15 |
| 1801339965 | Msa Alliance, LLC | Surgery | 2016 Vadalabene Dr, Suite B, Maryville, IL 62062-6901 | 2016-11-22 |
| 1184176612 | Robin Turner-viviano | Counselor | 2016 Vadalabene Dr, Suite A, Maryville, IL 62062-6901 | 2016-11-01 |
| 1902252174 | Brittany Pierson, LLC | Counselor | 2016 Vadalabene Dr, Suite A, Maryville, IL 62062-6901 | 2016-05-06 |
| 1912366436 | Kacey Panyik | Advanced Practice Midwife | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2016-02-11 |
| 1427416494 | Maryville Womens Center Ssr PC | Family Medicine | 2016 Vadalabene Dr, Suite B, Maryville, IL 62062-6901 | 2016-02-05 |
| 1639429376 | Brittany N Pierson | Counselor | 2016 Vadalabene Dr, Suite A, Maryville, IL 62062-6901 | 2012-09-10 |
| 1609018175 | Foley Dental Group, LLC | Dentist | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2009-03-30 |
| 1932357472 | Diana Lynn Herrick | Nurse Practitioner | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2008-09-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912293002 | Maryville Imaging, LLC | Clinic/Center | 2023 Vadalabene Dr, Suite 100, Maryville, IL 62062-5630 | 2011-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831134 | St Anthony's Memorial Hospital of The Hospital Sisters of The Third Or | Clinic/Center | 101 Coles Centre Pkwy, Ste 101, Mattoon, IL 61938 | 2020-04-30 |
| 1285255463 | Blessing Corporate Services, Inc | Clinic/Center | 927 Broadway St Ste 132, Quincy, IL 62301-2737 | 2020-04-29 |
| 1518505585 | Akumin Health Illinois, LLC | Clinic/Center | 820 E Terra Cotta Ave Ste 136, Crystal Lake, IL 60014-3650 | 2019-12-20 |
| 1992349724 | Home Diagnostics Plus LLC | Clinic/Center | 2154 W Rosemont Ave Ste 2f, Chicago, IL 60659-3226 | 2019-11-05 |
| 1639731839 | United Providers Inc | Clinic/Center | 9325 S Thomas Ave, Bridgeview, IL 60455-2163 | 2019-07-08 |
| 1861957144 | Rsr Medical | Clinic/Center | 1509 N Western Ave Unit 404, Chicago, IL 60622-1747 | 2019-01-31 |
| 1013429125 | Diagnostic Services LLC | Clinic/Center | 16101 Weber Rd Unit A, Crest Hill, IL 60403-8813 | 2017-10-30 |
| 1285157313 | Midwest Advanced Radiology Center, LLC | Clinic/Center | 11600 S Kedzie Ave Ste G, Merrionette Park, IL 60803-6308 | 2017-07-20 |
| 1063960276 | Mars Healthcare LLC | Clinic/Center | 721 W Highway 22nd, Lake Zurich, IL 60047 | 2016-09-16 |
| 1922456474 | Berwyn Imaging LLC | Clinic/Center | 6728 Cermak Rd, Berwyn, IL 60402-2217 | 2016-05-25 |
| Find all providers with the same taxonomy | ||||
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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.