Provider Demographics
NPI:1972639219
Name:ADVANCED OPEN MRI
Entity Type:Organization
Organization Name:ADVANCED OPEN MRI
Other - Org Name:GREEN OAK OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-446-2514
Mailing Address - Street 1:2111 WILSON BLVD
Mailing Address - Street 2:#700 PENN COMPANIES
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3001
Mailing Address - Country:US
Mailing Address - Phone:703-524-0400
Mailing Address - Fax:
Practice Address - Street 1:9802 FM 1960 BYPASS RD W
Practice Address - Street 2:#110
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3501
Practice Address - Country:US
Practice Address - Phone:281-446-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX034Medicare ID - Type UnspecifiedMC