Provider Demographics
NPI:1912017401
Name:SMR DIAGNOSTICS LTD
Entity Type:Organization
Organization Name:SMR DIAGNOSTICS LTD
Other - Org Name:ONE SOURCE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-517-5665
Mailing Address - Street 1:505 N RIDGEWAY DR
Mailing Address - Street 2:STE 252
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5118
Mailing Address - Country:US
Mailing Address - Phone:817-517-5665
Mailing Address - Fax:817-556-3999
Practice Address - Street 1:505 N RIDGEWAY DR
Practice Address - Street 2:STE 252
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5118
Practice Address - Country:US
Practice Address - Phone:817-517-5665
Practice Address - Fax:817-556-3999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMR DIAGNOSTICS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR26791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR26791OtherSTATE LICENSE
TX150682601Medicaid
TXFTA052Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER
TXR26791OtherSTATE LICENSE