MEDICARE: BASTROP OPEN MRI L L P PARTNERSHIP

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	261QR0200X	Radiology Clinic/Center	R27271	TX

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	:	1730212473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASTROP OPEN MRI L L P PARTNERSHIP

Provider Business Mailing Address
First Line	:	3101 HIGHWAY 71 E
Second Line	:	SUITE #108
City	:	BASTROP
State	:	TX
Zip	:	78602-5156
Country	:	US
Telephone Number	:	512-332-0222
Fax Number	:	512-332-0229

Provider Business Practice Location Address
First Line	:	3101 HIGHWAY 71 E
Second Line	:	SUITE #108
City	:	BASTROP
State	:	TX
Zip	:	78602-5156
Country	:	US
Telephone Number	:	512-332-0222
Fax Number	:	512-332-0229

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEVIN J OWENS
Credential	:
Telephone Number	:	512-332-0222

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	03/25/2011

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