Provider Demographics
NPI:1629184361
Name:OSTEO IMAGING INC
Entity Type:Organization
Organization Name:OSTEO IMAGING INC
Other - Org Name:IMAGING EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CDT
Authorized Official - Phone:915-545-2273
Mailing Address - Street 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:BLDG 1A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4646
Mailing Address - Country:US
Mailing Address - Phone:915-545-2273
Mailing Address - Fax:915-545-2203
Practice Address - Street 1:1201 E SCHUSTER AVE
Practice Address - Street 2:BLDG 1A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4646
Practice Address - Country:US
Practice Address - Phone:915-545-2273
Practice Address - Fax:915-545-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28046 / M00780261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177528001Medicaid
TX0387DCOtherBCBS OF TEXAS PROVIDER #
NM83635254Medicaid
TXP00085139Medicare ID - Type UnspecifiedRAILROAD MEDICARE ID #
NM83635254Medicaid