Provider Demographics
NPI:1790781714
Name:MRI CENTRAL LUBBOCK LLC
Entity Type:Organization
Organization Name:MRI CENTRAL LUBBOCK LLC
Other - Org Name:MRI CENTRAL LUBBOCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:F
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-368-9966
Mailing Address - Street 1:12225 GREENVILLE AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9338
Mailing Address - Country:US
Mailing Address - Phone:877-361-8018
Mailing Address - Fax:888-542-6858
Practice Address - Street 1:4511 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-3615
Practice Address - Country:US
Practice Address - Phone:806-281-0111
Practice Address - Fax:806-788-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8685442OtherCIGNA
TX2242044OtherFIRST HEALTH CCN
TX362537100OtherOWCP
TX7675373OtherAETNA
TX152053801Medicaid
TX2202558OtherUHC
TX0224DCOtherBCBS TX
TXFTX089Medicare PIN
TX362537100OtherOWCP
TX152053801Medicaid