MEDICARE: UPRIGHT MRI OF CLEARLAKE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154341428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPRIGHT MRI OF CLEARLAKE LLC

Provider Business Mailing Address
First Line	:	3502 SPID
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415
Country	:	US
Telephone Number	:	361-854-4400
Fax Number	:	361-854-4420

Provider Business Practice Location Address
First Line	:	1202 NASA PARKWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3304
Country	:	US
Telephone Number	:	281-335-0505
Fax Number	:	281-335-2020

Authorized Official
Title or Position	:	COO
Name	:	VERONICA JOHNSON
Credential	:
Telephone Number	:	361-806-5710

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/16/2016

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