MEDICARE: UNIVERSAL MRI AND DIAGNOSTICS INC

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		TX
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1790725331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MRI AND DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	PO BOX 1647
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77522-1647
Country	:	US
Telephone Number	:	281-422-9900
Fax Number	:	281-422-9910

Provider Business Practice Location Address
First Line	:	2321 SOUTHWEST FREWWAY
Second Line	:	#B
City	:	HOUSTON
State	:	TX
Zip	:	77098-4701
Country	:	US
Telephone Number	:	281-422-9900
Fax Number	:	281-224-9910

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BETH E DEL VALLE
Credential	:
Telephone Number	:	281-422-9900

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	02/12/2013

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