MEDICARE: CORPUS CHRISTI MRI LTD

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	:	1003087214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORPUS CHRISTI MRI LTD

Provider Business Mailing Address
First Line	:	5945 MCARDLE RD # 125
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-3490
Country	:	US
Telephone Number	:	361-652-0025
Fax Number	:	361-485-0834

Provider Business Practice Location Address
First Line	:	8902 N NAVARRO ST STE 400
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1422
Country	:	US
Telephone Number	:	361-652-0025
Fax Number	:	361-485-0834

Authorized Official
Title or Position	:	STARTUP COORDINATOR
Name	:	MRS. D JANE BAGNALL
Credential	:
Telephone Number	:	361-570-1900

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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