Provider Demographics
NPI:1669475505
Name:HORIZON MRI OF SAN ANTONIO WEST LLC
Entity Type:Organization
Organization Name:HORIZON MRI OF SAN ANTONIO WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-925-3490
Mailing Address - Street 1:240 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5945
Mailing Address - Country:US
Mailing Address - Phone:941-925-3490
Mailing Address - Fax:941-953-4452
Practice Address - Street 1:2140 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4424
Practice Address - Country:US
Practice Address - Phone:210-692-0674
Practice Address - Fax:210-949-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
242744OtherAMERIGROUP
7126556OtherAETNA/MEDSOLUTIONS-PPO
TX0343DCOtherBCBS PROV #
3537015OtherAETNA/MEDSOLUTONS -HMO
7126556OtherAETNA/MEDSOLUTIONS-PPO