Provider Demographics
NPI:1982639977
Name:CROSSROADS MRI LP
Entity Type:Organization
Organization Name:CROSSROADS MRI LP
Other - Org Name:CROSSROADS MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/MARKETING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-485-9400
Mailing Address - Street 1:8806 N NAVARRO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1556
Mailing Address - Country:US
Mailing Address - Phone:361-485-9400
Mailing Address - Fax:361-485-9933
Practice Address - Street 1:8806 N NAVARRO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1556
Practice Address - Country:US
Practice Address - Phone:361-485-9400
Practice Address - Fax:361-485-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0599DCOtherBCBS
TX189783701Medicaid
TXP00407263OtherMEDICARE RR
TXP00407263OtherMEDICARE RR