Provider Demographics
NPI:1619252863
Name:CMU IMAGING CENTER LLC
Entity Type:Organization
Organization Name:CMU IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRELLON
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R) (ARRT)
Authorized Official - Phone:956-583-0004
Mailing Address - Street 1:PO BOX 2763
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2763
Mailing Address - Country:US
Mailing Address - Phone:956-583-0004
Mailing Address - Fax:956-583-5790
Practice Address - Street 1:1300 S BRYAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-583-0004
Practice Address - Fax:956-583-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)