Provider Demographics
NPI:1174526107
Name:OPEN IMAGING-LAYTON, LLC
Entity type:Organization
Organization Name:OPEN IMAGING-LAYTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAN KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-653-3968
Mailing Address - Street 1:PO BOX 641825
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-1825
Mailing Address - Country:US
Mailing Address - Phone:888-674-7933
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:2071 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4970
Practice Address - Country:US
Practice Address - Phone:801-825-4040
Practice Address - Fax:801-825-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000090724Medicare PIN
UT000090724Medicare PIN