Provider Demographics
NPI:1134315310
Name:OPEN MRI OF LUBBOCK
Entity Type:Organization
Organization Name:OPEN MRI OF LUBBOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEMP
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-706-4455
Mailing Address - Street 1:3720 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1208
Mailing Address - Country:US
Mailing Address - Phone:806-792-6736
Mailing Address - Fax:806-792-6743
Practice Address - Street 1:3720 20TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1208
Practice Address - Country:US
Practice Address - Phone:806-792-6736
Practice Address - Fax:806-792-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0651DCOtherBLUE CROSS BLUE SHIELD
TX0651DCOtherBLUE CROSS BLUE SHIELD