MEDICARE: CHAMPLAIN VALLEY OPEN MRI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1215986575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPLAIN VALLEY OPEN MRI LLC

Provider Business Mailing Address
First Line	:	118 CONSUMER SQ
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6507
Country	:	US
Telephone Number	:	518-562-3650
Fax Number	:	518-562-3801

Provider Business Practice Location Address
First Line	:	118 CONSUMER SQ
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6507
Country	:	US
Telephone Number	:	518-562-3650
Fax Number	:	518-562-3801

Authorized Official
Title or Position	:	CONTRACT MANAGER
Name	:	MICHELLE DOUGLAS
Credential	:
Telephone Number	:	502-403-1401

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	12/05/2008

Similar Medicare Providers

1073516126 — LUIS F GONZALEZ, III, MD, PC
Practice Location Address:

118 CONSUMER SQ
PLATTSBURGH, NY
12901-6507

Practice Phone: 518-562-3650
Practice Fax: 518-562-3801

1245758150 — DR. SWETA DAS OD
Practice Location Address:

110 CONSUMER SQ
PLATTSBURGH, NY
12901-6507

Practice Phone: 518-562-0200
Practice Fax:

1215869631 — MAKENZIE WRIGHT
Practice Location Address:

6 STONEGATE WAY APT 4
PLATTSBURGH, NY
12901-5034

Practice Phone: 908-300-1776
Practice Fax:

1427711407 — IAN MATTHEW WINSOME LMHC
Practice Location Address:

5114 N CATHERINE ST
PLATTSBURGH, NY
12901-3380

Practice Phone: 518-227-0294
Practice Fax:

1013910256 — DR. JOSE MARIA ACOSTAMADIEDO MD
Practice Location Address:

212 CORNELIA ST
PLATTSBURGH, NY
12901-2306

Practice Phone: 518-562-7100
Practice Fax:

1215930292 — CGSR, INC
Practice Location Address:

154 PROSPECT AVE
PLATTSBURGH, NY
12901-1302

Practice Phone: 518-563-5440
Practice Fax: 518-563-1206

Directions to “CHAMPLAIN VALLEY OPEN MRI LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.