Provider Demographics
NPI:1780733261
Name:TRI COUNTY OPEN MRI, LLC
Entity type:Organization
Organization Name:TRI COUNTY OPEN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DUKE
Authorized Official - Last Name:WESTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-866-4141
Mailing Address - Street 1:236 DR JOE PETTY ROAD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642
Mailing Address - Country:US
Mailing Address - Phone:270-866-6979
Mailing Address - Fax:
Practice Address - Street 1:236 JOE PETTY RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642
Practice Address - Country:US
Practice Address - Phone:270-866-9799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY148792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941619Medicaid
KY9167Medicare PIN
KYP00222067Medicare PIN
KYDD3381Medicare PIN
D53809Medicare UPIN