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NPI Code Detail

MEDICARE: GALAXY MRI AND DIAGNOSTIC CENTER

MEDICARE: GALAXY MRI AND DIAGNOSTIC CENTER
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
1246XS1301XSonography Specialist/Technologist Cardiovascular
2261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center
32471S1302XSonography Radiologic Technologist
42471V0105XVascular Sonography Radiologic Technologist
52471C3401XComputed Tomography Radiologic TechnologistR29608TX
62471C3402XRadiography Radiologic TechnologistR29608TX
72471M1202XMagnetic Resonance Imaging Radiologic TechnologistTX
8293D00000XPhysiological Laboratory
9291U00000XClinical Medical Laboratory45D1103817TX
10261QR0200XRadiology Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
245D1103817OTHERTXCLIA

General Provider Information

NPI Number : 1528121340
Entity Type Code : Organization
Provider Name (Legal Business Name) : GALAXY MRI AND DIAGNOSTIC CENTER
Provider Business Mailing Address
First Line : 1110 N GALLOWAY AVE
Second Line :
City : MESQUITE
State : TX
Zip : 75149-2436
Country : US
Telephone Number : 972-331-4481
Fax Number : 972-331-4486
Provider Business Practice Location Address
First Line : 1110 N GALLOWAY AVE
Second Line :
City : MESQUITE
State : TX
Zip : 75149-2436
Country : US
Telephone Number : 972-331-4481
Fax Number : 972-331-4486
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. JOHN TEIG PORT
Credential : M.D.
Telephone Number : 972-331-4481
Provider Enumeration Date : 12/19/2006
Last Update Date : 06/15/2011

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