Provider Demographics
NPI:1609312263
Name:MRI CENTERS OF TEXAS, LLC - FORT WORTH CENTRAL SERIES
Entity Type:Organization
Organization Name:MRI CENTERS OF TEXAS, LLC - FORT WORTH CENTRAL SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARDELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-466-1054
Mailing Address - Street 1:PO BOX 224852
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4852
Mailing Address - Country:US
Mailing Address - Phone:817-226-1800
Mailing Address - Fax:817-226-1802
Practice Address - Street 1:1000 LIPSCOMB ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3180
Practice Address - Country:US
Practice Address - Phone:817-226-1800
Practice Address - Fax:817-226-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty