MEDICARE: MEMORIAL MRI AND 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	2085B0100X	Body Imaging Physician	R26701	TX
2	2085N0904X	Nuclear Radiology Physician	R26701	TX
3	2085R0203X	Therapeutic Radiology Physician	R26701	TX
4	2085R0204X	Vascular & Interventional Radiology Physician	R26701	TX
5	2085U0001X	Diagnostic Ultrasound Physician	R26701	TX
6	2085R0202X	Diagnostic Radiology Physician	R26701	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0203DC	OTHER	TX	BLUE CROSS PROVIDER#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912989120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL MRI AND DIAGNOSTIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 55159
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77255-5159
Country	:	US
Telephone Number	:	713-461-3399
Fax Number	:	713-461-1969

Provider Business Practice Location Address
First Line	:	1346 CAMPBELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-6404
Country	:	US
Telephone Number	:	713-461-3399
Fax Number	:	713-463-5996

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	FRED HUANG
Credential	:
Telephone Number	:	713-461-3399

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/17/2025

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Directions to “MEMORIAL MRI AND DIAGNOSTIC LLC ” Practice Location

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