Provider Demographics
NPI:1184091100
Name:ALLIANCE MRI CLEARLAKE
Entity type:Organization
Organization Name:ALLIANCE MRI CLEARLAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-420-5011
Mailing Address - Street 1:800 GESSNER RD
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4276
Mailing Address - Country:US
Mailing Address - Phone:713-468-3842
Mailing Address - Fax:
Practice Address - Street 1:17490 HIGHWAY 3
Practice Address - Street 2:SUITE B-300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4160
Practice Address - Country:US
Practice Address - Phone:713-351-4976
Practice Address - Fax:713-263-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)