Healthcare Provider Details

I. General information

NPI: 1912090929
Provider Name (Legal Business Name): NORTHSIDE OPEN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 CORNERSTONE BLVD
EDINBURG TX
78539-9122
US

IV. Provider business mailing address

2616 CORNERSTONE BLVD
EDINBURG TX
78539-9122
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-2976
  • Fax:
Mailing address:
  • Phone: 956-687-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: ISABEL JIMENEZ
Title or Position: OFFICE SUPERVISOR
Credential:
Phone: 956-687-2976