Provider Demographics
NPI:1275014565
Name:TRINITY CENTER OPEN MRI
Entity Type:Organization
Organization Name:TRINITY CENTER OPEN MRI
Other - Org Name:TRINITY CENTER OPEN MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-682-4004
Mailing Address - Street 1:1110 MARSHALL STREET
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-682-4004
Mailing Address - Fax:
Practice Address - Street 1:1110 MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045
Practice Address - Country:US
Practice Address - Phone:956-725-6736
Practice Address - Fax:956-725-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR31643261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192071201Medicaid