Basic Information
| Provider Information | |||||||||
| NPI: | 1134315310 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN MRI OF LUBBOCK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3720 20TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067926736 | ||||||||
| FaxNumber: | 8067926743 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 20TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067926736 | ||||||||
| FaxNumber: | 8067926743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | LAIDLEY | ||||||||
| AuthorizedOfficialFirstName: | KEMP | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5057064455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 0651DC | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |