Basic Information
| Provider Information | |||||||||
| NPI: | 1568695625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUBBOCK OPEN AIR MRI INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3720 20TH ST | ||||||||
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| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067926736 | ||||||||
| FaxNumber: | 8067926743 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 20TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067926736 | ||||||||
| FaxNumber: | 8067926743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | NEIDERT | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8067926736 | ||||||||
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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) |
No ID Information.