MEDICARE: SW MRI & DIAGNOSTIC LP

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1134205990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SW MRI & DIAGNOSTIC LP

Provider Business Mailing Address
First Line	:	1051 PINELOCH DR
Second Line	:	SUITE 175
City	:	HOUSTON
State	:	TX
Zip	:	77062-2742
Country	:	US
Telephone Number	:	281-488-7226
Fax Number	:	281-488-2077

Provider Business Practice Location Address
First Line	:	4001 W SAM HOUSTON PKWY N
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77043-1235
Country	:	US
Telephone Number	:	713-996-0900
Fax Number	:	713-996-0901

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES MICHAEL LATHAM
Credential	:
Telephone Number	:	281-488-7226

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/28/2008

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