Provider Demographics
NPI:1033164041
Name:UNIVERSAL MRI AND DIAGNOSTICS INC
Entity Type:Organization
Organization Name:UNIVERSAL MRI AND DIAGNOSTICS INC
Other - Org Name:UNIVERSAL CONROE MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-422-9900
Mailing Address - Street 1:PO BOX 22789
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-2789
Mailing Address - Country:US
Mailing Address - Phone:936-756-3388
Mailing Address - Fax:936-756-3630
Practice Address - Street 1:200 RIVER POINTE DR.
Practice Address - Street 2:#130
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2814
Practice Address - Country:US
Practice Address - Phone:936-756-3388
Practice Address - Fax:936-756-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTA019Medicare PIN