Basic Information
| Provider Information | |||||||||
| NPI: | 1922104850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH LOOP MRI LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2569 | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774972569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136641330 | ||||||||
| FaxNumber: | 7135926772 | ||||||||
| Practice Location | |||||||||
| Address1: | 2616 S LOOP W | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136656767 | ||||||||
| FaxNumber: | 7136640327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 2817727749 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.