Provider Demographics
NPI:1467638593
Name:MRI DIAGNOSTIC,INC
Entity Type:Organization
Organization Name:MRI DIAGNOSTIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ELLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-265-1330
Mailing Address - Street 1:606 E GLENOAKS BLVD
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1779
Mailing Address - Country:US
Mailing Address - Phone:818-265-1330
Mailing Address - Fax:818-265-1336
Practice Address - Street 1:606 E GLENOAKS BLVD
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1779
Practice Address - Country:US
Practice Address - Phone:818-265-1330
Practice Address - Fax:818-265-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA858462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH11265Medicare UPIN
CAW21927Medicare PIN
CAA85846Medicare PIN