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NPI Code Detail

MEDICARE: MRI GROUP LP

MEDICARE: MRI GROUP 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
1261QR0200XRadiology Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1629148788
Entity Type Code : Organization
Provider Name (Legal Business Name) : MRI GROUP LP
Provider Business Mailing Address
First Line : 4400 OAK PARK LANE
Second Line :
City : FT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 817-207-9600
Fax Number : 817-207-9692
Provider Business Practice Location Address
First Line : 4400 OAK PARK LANE
Second Line :
City : FT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 817-207-9600
Fax Number : 817-207-9692
Authorized Official
Title or Position : COO
Name : MR. CHARLES W DILLON
Credential :
Telephone Number : 817-207-9600
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/22/2020

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