Provider Demographics
NPI:1275994477
Name:OPTIMUM DIAGNOSTIC IMAGING CENTER
Entity Type:Organization
Organization Name:OPTIMUM DIAGNOSTIC IMAGING CENTER
Other - Org Name:OPTIMUM IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-0004
Mailing Address - Street 1:1300 S BRYAN RD
Mailing Address - Street 2:STE 104
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6626
Mailing Address - Country:US
Mailing Address - Phone:956-583-0004
Mailing Address - Fax:956-583-5790
Practice Address - Street 1:1300 S BRYAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-583-0004
Practice Address - Fax:956-583-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR41088261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology