MEDICARE: MISSION OPEN MRI & DIAGNOSTIC CENTER 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	F5201	TX

General Provider Information

NPI Number	:	1427141415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION OPEN MRI & DIAGNOSTIC CENTER LLC

Provider Business Mailing Address
First Line	:	909 BUSINESS PARK DR STE 1
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-6054
Country	:	US
Telephone Number	:	956-585-8700
Fax Number	:	956-424-1384

Provider Business Practice Location Address
First Line	:	909 BUSINESS PARK DR STE 1
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-6054
Country	:	US
Telephone Number	:	956-585-8700
Fax Number	:	956-424-1384

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. HUMBERTO ESPINOZA
Credential	:
Telephone Number	:	956-585-8700

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/28/2012

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