Provider Demographics
NPI:1326261231
Name:MAN RIK, INC.
Entity Type:Organization
Organization Name:MAN RIK, INC.
Other - Org Name:LONE STAR X-RAY CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-578-9729
Mailing Address - Street 1:PO BOX 3443
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3443
Mailing Address - Country:US
Mailing Address - Phone:361-578-9729
Mailing Address - Fax:361-578-9734
Practice Address - Street 1:2501 E AIRLINE RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4307
Practice Address - Country:US
Practice Address - Phone:361-578-9729
Practice Address - Fax:361-578-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14176335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0861072-01Medicaid
TX459869Medicare UPIN