Provider Demographics
NPI:1043278096
Name:VICTORIA MRI LTD
Entity Type:Organization
Organization Name:VICTORIA MRI LTD
Other - Org Name:VICTORIA UPRIGHT MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:D
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BAGNALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-570-1900
Mailing Address - Street 1:8902 N NAVARRO ST
Mailing Address - Street 2:STE 400
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1414
Mailing Address - Country:US
Mailing Address - Phone:361-570-1900
Mailing Address - Fax:361-485-0063
Practice Address - Street 1:8902 N NAVARRO ST
Practice Address - Street 2:STE 400
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1414
Practice Address - Country:US
Practice Address - Phone:361-570-1900
Practice Address - Fax:361-485-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX476DCOtherBCBS PROVIDER NUMBER
TX476DCOtherBCBS PROVIDER NUMBER