Provider Demographics
NPI:1649751058
Name:MRI CENTERS OF TEXAS LLC - SAN ANTONIO SERIES
Entity Type:Organization
Organization Name:MRI CENTERS OF TEXAS LLC - SAN ANTONIO SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BROOKSON
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-507-6783
Mailing Address - Street 1:420 S CESAR CHAVEZ BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5806
Mailing Address - Country:US
Mailing Address - Phone:817-226-1800
Mailing Address - Fax:
Practice Address - Street 1:4400 VANCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5323
Practice Address - Country:US
Practice Address - Phone:210-468-2975
Practice Address - Fax:210-468-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty