MEDICARE: OAK TREE DIAGNOSTIC, 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

General Provider Information

NPI Number	:	1841203643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK TREE DIAGNOSTIC, LLC

Provider Business Mailing Address
First Line	:	720 AVENUE F N
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-9573
Country	:	US
Telephone Number	:	979-245-9797
Fax Number	:	979-245-9789

Provider Business Practice Location Address
First Line	:	720 AVENUE F N
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-9573
Country	:	US
Telephone Number	:	979-245-9797
Fax Number	:	979-245-9789

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LUPE LIBERONI
Credential	:
Telephone Number	:	979-245-9797

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/22/2020

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