Provider Demographics
NPI:1417918756
Name:FRANK OLNEY & RUDY NICOLAS PTRS
Entity Type:Organization
Organization Name:FRANK OLNEY & RUDY NICOLAS PTRS
Other - Org Name:611 OPEN MRI/CT, 611 MRI-CT, 611 MRI ALTOONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-946-8000
Mailing Address - Street 1:2950 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4494
Mailing Address - Country:US
Mailing Address - Phone:814-946-8000
Mailing Address - Fax:814-946-8002
Practice Address - Street 1:2950 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4494
Practice Address - Country:US
Practice Address - Phone:814-946-8000
Practice Address - Fax:814-946-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X174400000X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001198051Medicaid
PAC34835Medicare UPIN
PAC31041Medicare UPIN
PA001198051Medicaid
PA257839Medicare PIN
PAC28256Medicare UPIN
PAB33460Medicare UPIN
PAF30139Medicare UPIN
PAE65843Medicare UPIN
PAB33460Medicare UPIN