Provider Demographics
NPI:1841244779
Name:OPEN MRI OF NEW MEXICO
Entity Type:Organization
Organization Name:OPEN MRI OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-327-6688
Mailing Address - Street 1:2700 FARMINGTON AVE
Mailing Address - Street 2:BLDG F2
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4559
Mailing Address - Country:US
Mailing Address - Phone:505-327-6688
Mailing Address - Fax:505-327-6690
Practice Address - Street 1:2700 FARMINGTON AVE
Practice Address - Street 2:BLDG F2
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4559
Practice Address - Country:US
Practice Address - Phone:505-327-6688
Practice Address - Fax:505-327-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-041801-00-1207RM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty