Provider Demographics
NPI:1790705192
Name:UNIVERSAL MRI AND DIAGNOSTICS INC
Entity Type:Organization
Organization Name:UNIVERSAL MRI AND DIAGNOSTICS INC
Other - Org Name:UNIVERSAL HUMBLE MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-960-8194
Mailing Address - Street 1:PO BOX 22789
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-2789
Mailing Address - Country:US
Mailing Address - Phone:281-422-9900
Mailing Address - Fax:281-422-9910
Practice Address - Street 1:19007 HIGHWAY 59 STE 100
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4267
Practice Address - Country:US
Practice Address - Phone:281-446-0111
Practice Address - Fax:281-446-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTA019Medicare PIN