Provider Demographics
NPI:1578626875
Name:SOUTH TEXAS MRI LTD
Entity Type:Organization
Organization Name:SOUTH TEXAS MRI LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:210-616-7796
Mailing Address - Street 1:7930 FLOYD CURL DR FL 2
Mailing Address - Street 2:P. O. BOX 291088
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3925
Mailing Address - Country:US
Mailing Address - Phone:210-617-9850
Mailing Address - Fax:210-616-7749
Practice Address - Street 1:7930 FLOYD CURL DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3925
Practice Address - Country:US
Practice Address - Phone:210-617-9850
Practice Address - Fax:210-616-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127701401Medicaid
TXTXB106950OtherSTMRI MEDICARE
300026383Medicare PIN