Provider Demographics
NPI:1053322479
Name:INFINITY MRI & DIAGNOSTICS - ILP
Entity Type:Organization
Organization Name:INFINITY MRI & DIAGNOSTICS - ILP
Other - Org Name:INFINITY MRI UBZ
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GODBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-579-2991
Mailing Address - Street 1:1718 N FRY ROAD
Mailing Address - Street 2:#100A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084
Mailing Address - Country:US
Mailing Address - Phone:281-579-2991
Mailing Address - Fax:281-579-2182
Practice Address - Street 1:1718 N FRY ROAD
Practice Address - Street 2:SUITE 100A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084
Practice Address - Country:US
Practice Address - Phone:281-579-2991
Practice Address - Fax:281-579-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28699261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTXU32Medicare ID - Type Unspecified