Provider Demographics
NPI:1457357014
Name:DIAGNOSTIC MRI LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-252-4363
Mailing Address - Street 1:11375 W. SAM HOUSTON PKWY S.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-2303
Mailing Address - Country:US
Mailing Address - Phone:281-879-6800
Mailing Address - Fax:281-879-5994
Practice Address - Street 1:11375 W. SAM HOUTSON PKWY SOUTH
Practice Address - Street 2:#150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:281-879-6800
Practice Address - Fax:281-879-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88043701Medicaid
TXFTA051Medicare ID - Type Unspecified