Provider Demographics
NPI:1669412219
Name:UNIVERSAL TOWN & COUNTRY MRI
Entity type:Organization
Organization Name:UNIVERSAL TOWN & COUNTRY MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARVIZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:713-960-8104
Mailing Address - Street 1:PO BOX 22789
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-2789
Mailing Address - Country:US
Mailing Address - Phone:713-622-4480
Mailing Address - Fax:713-622-4465
Practice Address - Street 1:10929 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2203
Practice Address - Country:US
Practice Address - Phone:713-465-5845
Practice Address - Fax:713-465-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTA019Medicare PIN