Provider Demographics
NPI:1962455378
Name:LIVINGSTON MRI, LLP
Entity Type:Organization
Organization Name:LIVINGSTON MRI, LLP
Other - Org Name:LIVINGSTON DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:936-329-6288
Mailing Address - Street 1:PO BOX 9815
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387
Mailing Address - Country:US
Mailing Address - Phone:281-681-8040
Mailing Address - Fax:281-296-0093
Practice Address - Street 1:300 BYPASS LANE #208
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-329-6288
Practice Address - Fax:936-329-6289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVINGSTON MRI LLP DBA LIVINGSTON DIAGNOSTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5728261QR0200X
335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730020-01Medicaid
TXFTSX02Medicare PIN