MEDICARE: SOUTH TEXAS 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	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB106950	OTHER	TX	STMRI MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578626875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS MRI LTD

Provider Business Mailing Address
First Line	:	7930 FLOYD CURL DR FL 2
Second Line	:	P. O. BOX 291088
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3925
Country	:	US
Telephone Number	:	210-617-9850
Fax Number	:	210-616-7749

Provider Business Practice Location Address
First Line	:	7930 FLOYD CURL DR
Second Line	:	2ND FLOOR
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3925
Country	:	US
Telephone Number	:	210-617-9850
Fax Number	:	210-616-7749

Authorized Official
Title or Position	:	AGENT
Name	:	MR. PHILIP J. RUSSELL
Credential	:	CMPE
Telephone Number	:	210-616-7796

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/09/2010

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