| Community Open Mri Of Auburn Llc | |
|
2428 Lake Ave Fort Wayne IN 46805-5406 | |
| (260) 422-1491 | |
| (260) 423-1421 |
| Full Name | Community Open Mri Of Auburn Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2428 Lake Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | John Steven Platusic (COO) |
| Authorized Official Contact | 8043631007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Open Mri Of Auburn Llc 2428 Lake Ave Fort Wayne IN 46805-5406 Ph: (260) 422-1491 | Community Open Mri Of Auburn Llc 2428 Lake Ave Fort Wayne IN 46805-5406 Ph: (260) 422-1491 |
| NPI Number | 1023201316 |
|---|---|
| Provider Enumeration Date | 08/21/2007 |
| Last Update Date | 04/09/2024 |
| Medicare PECOS PAC ID | 9234100256 |
|---|---|
| Medicare Enrollment ID | O20071204000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023201316 | NPI | - | NPPES |
| 200414630A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QM1200X | Clinic/center - Magnetic Resonance Imaging (mri) | (* (Not Available)) | Primary |
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