MEDICARE: DAVIS LANDING MRI & IMAGING 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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0356DC	OTHER	TX	BLUE CROSS BLUE SHIELD
2	0208507	OTHER	WA	DEPT OF LABOR AND IND
3	00MDXO	OTHER	TX	HEALTHSMART

General Provider Information

NPI Number	:	1508882481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS LANDING MRI & IMAGING LP

Provider Business Mailing Address
First Line	:	2795 PHARMACY RD
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6201
Country	:	US
Telephone Number	:	956-487-5621
Fax Number	:	956-716-8378

Provider Business Practice Location Address
First Line	:	2795 PHARMACY RD
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6201
Country	:	US
Telephone Number	:	956-487-5621
Fax Number	:	956-716-8378

Authorized Official
Title or Position	:	OWNER/ADM
Name	:	GAURI KANHERE
Credential	:	MD
Telephone Number	:	956-487-4335

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/22/2020

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