MEDICARE: OPEN MRI OF DALLAS LLC

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	:	1477999357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF DALLAS LLC

Provider Business Mailing Address
First Line	:	PO BOX 763504
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75376-3504
Country	:	US
Telephone Number	:	214-613-9682
Fax Number	:	214-331-3096

Provider Business Practice Location Address
First Line	:	2701 S HAMPTON RD
Second Line	:	STE 150
City	:	DALLAS
State	:	TX
Zip	:	75224-2367
Country	:	US
Telephone Number	:	214-613-9682
Fax Number	:	214-331-3096

Authorized Official
Title or Position	:	OWNER
Name	:	RAFATH QURAISHI
Credential	:	M.D.
Telephone Number	:	956-821-2376

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	05/17/2013

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