MEDICARE: VICTORIA 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	476DC	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1043278096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA MRI LTD

Provider Business Mailing Address
First Line	:	8902 N NAVARRO ST
Second Line	:	STE 400
City	:	VICTORIA
State	:	TX
Zip	:	77904-1414
Country	:	US
Telephone Number	:	361-570-1900
Fax Number	:	361-485-0063

Provider Business Practice Location Address
First Line	:	8902 N NAVARRO ST
Second Line	:	STE 400
City	:	VICTORIA
State	:	TX
Zip	:	77904-1414
Country	:	US
Telephone Number	:	361-570-1900
Fax Number	:	361-485-0063

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	12/20/2007

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Directions to “VICTORIA MRI LTD ” Practice Location

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