Provider Demographics
NPI:1093094989
Name:TOMBALL MRI, INC
Entity Type:Organization
Organization Name:TOMBALL MRI, INC
Other - Org Name:AMERICAN HEALTH IMAGING OF TOMBALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-689-1691
Mailing Address - Street 1:PO BOX 746530
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6530
Mailing Address - Country:US
Mailing Address - Phone:877-275-9077
Mailing Address - Fax:
Practice Address - Street 1:425 HOLDERRIETH BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4543
Practice Address - Country:US
Practice Address - Phone:281-207-8800
Practice Address - Fax:281-207-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB160521Medicare PIN