Healthcare Provider Details

I. General information

NPI: 1457357014
Provider Name (Legal Business Name): DIAGNOSTIC MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 W. SAM HOUTSON PKWY SOUTH #150
HOUSTON TX
77030
US

IV. Provider business mailing address

11375 W. SAM HOUSTON PKWY S. SUITE 150
HOUSTON TX
77031-2303
US

V. Phone/Fax

Practice location:
  • Phone: 281-879-6800
  • Fax: 281-879-5994
Mailing address:
  • Phone: 281-879-6800
  • Fax: 281-879-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DON BALLARD
Title or Position: CEO
Credential:
Phone: 303-252-4363