Provider Demographics
NPI:1417134974
Name:INTEGRATED MRI & DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:INTEGRATED MRI & DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-488-7226
Mailing Address - Street 1:1051 PINELOCH DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2742
Mailing Address - Country:US
Mailing Address - Phone:281-488-7226
Mailing Address - Fax:281-488-2077
Practice Address - Street 1:1051 PINELOCH DR
Practice Address - Street 2:SUITE 175
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2742
Practice Address - Country:US
Practice Address - Phone:281-488-7226
Practice Address - Fax:281-488-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00526VMedicare PIN