MEDICARE: APEX ULTRA MRI GP 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	:	1912056417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX ULTRA MRI GP LLC

Provider Business Mailing Address
First Line	:	1320 AIRPORT FWY STE B
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6777
Country	:	US
Telephone Number	:	817-864-9696
Fax Number	:	817-864-9369

Provider Business Practice Location Address
First Line	:	5350 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7209
Country	:	US
Telephone Number	:	817-864-9696
Fax Number	:	817-864-9369

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRIS MOTHERWELL
Credential	:
Telephone Number	:	817-864-9696

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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