Provider Demographics
NPI:1043329634
Name:OTSEGO MAGNETIC RESONANCE IMAGING CENTER
Entity type:Organization
Organization Name:OTSEGO MAGNETIC RESONANCE IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-432-8272
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-0159
Mailing Address - Country:US
Mailing Address - Phone:607-432-8272
Mailing Address - Fax:607-432-8274
Practice Address - Street 1:1 FOX CARE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2086
Practice Address - Country:US
Practice Address - Phone:607-432-8272
Practice Address - Fax:607-432-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1164Medicare ID - Type UnspecifiedMED PROVIDER GROUP NO