Provider Demographics
NPI:1417984493
Name:OPENSIDED MRI OF SAN ANTONIO LLC
Entity Type:Organization
Organization Name:OPENSIDED MRI OF SAN ANTONIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-217-7114
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4849
Mailing Address - Country:US
Mailing Address - Phone:888-692-6736
Mailing Address - Fax:210-692-0821
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4849
Practice Address - Country:US
Practice Address - Phone:888-692-6736
Practice Address - Fax:210-692-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1882292201Medicaid
TX1882292201Medicaid
TXFTX210Medicare PIN