MEDICARE: HORIZON MRI OF SAN ANTONIO WEST 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	242744	OTHER		AMERIGROUP
2	7126556	OTHER		AETNA/MEDSOLUTIONS-PPO
3	0343DC	OTHER	TX	BCBS PROV #
4	3537015	OTHER		AETNA/MEDSOLUTONS -HMO

General Provider Information

NPI Number	:	1669475505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON MRI OF SAN ANTONIO WEST LLC

Provider Business Mailing Address
First Line	:	240 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-5945
Country	:	US
Telephone Number	:	941-925-3490
Fax Number	:	941-953-4452

Provider Business Practice Location Address
First Line	:	2140 BABCOCK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4424
Country	:	US
Telephone Number	:	210-692-0674
Fax Number	:	210-949-1878

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. MARTIN J KERN
Credential	:
Telephone Number	:	941-925-3490

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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