Provider Demographics
NPI:1356394894
Name:OPEN AIR MRI OF AMARILLO, LP
Entity type:Organization
Organization Name:OPEN AIR MRI OF AMARILLO, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALWORTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-353-8333
Mailing Address - Street 1:7400 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1818
Mailing Address - Country:US
Mailing Address - Phone:806-353-8333
Mailing Address - Fax:806-353-8332
Practice Address - Street 1:7400 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1818
Practice Address - Country:US
Practice Address - Phone:806-353-8333
Practice Address - Fax:806-353-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080684601Medicaid
TX000G4358Medicaid
TX000G4358Medicaid