MEDICARE: MRI CENTERS OF TEXAS LLC- EL PASO SERIES

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1124841366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MRI CENTERS OF TEXAS LLC- EL PASO SERIES

Provider Business Mailing Address
First Line	:	PO BOX 224852
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-4852
Country	:	US
Telephone Number	:	817-226-1800
Fax Number	:	817-226-1802

Provider Business Practice Location Address
First Line	:	171 S ALTO MESA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4418
Country	:	US
Telephone Number	:	817-226-1800
Fax Number	:	817-226-1802

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT SHIELDS
Credential	:
Telephone Number	:	817-226-1800

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	11/06/2024

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