Provider Demographics
NPI:1508141060
Name:LAREDO OMI, INC
Entity Type:Organization
Organization Name:LAREDO OMI, INC
Other - Org Name:LAREDO OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-592-9191
Mailing Address - Street 1:229 ARNOLD MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4145
Mailing Address - Country:US
Mailing Address - Phone:770-592-9191
Mailing Address - Fax:
Practice Address - Street 1:209 W VILLAGE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2227
Practice Address - Country:US
Practice Address - Phone:956-728-1177
Practice Address - Fax:956-728-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)