Provider Demographics
NPI:1215544408
Name:MID-TEXAS MRI, LLC
Entity Type:Organization
Organization Name:MID-TEXAS MRI, LLC
Other - Org Name:MILLENNIUM MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-623-3211
Mailing Address - Street 1:2929 S CARAWAY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7335
Mailing Address - Country:US
Mailing Address - Phone:810-623-3211
Mailing Address - Fax:432-400-2599
Practice Address - Street 1:811 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4201
Practice Address - Country:US
Practice Address - Phone:432-227-0067
Practice Address - Fax:432-400-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty