1407876881 NPI number — LAREDO OPEN MRI LLC

Table of content: (NPI 1407876881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407876881 NPI number — LAREDO OPEN MRI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAREDO OPEN MRI LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407876881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22710 EXECUTIVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-464-0318
Provider Business Mailing Address Fax Number:
703-464-0319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6019 MCPHERSON RD
Provider Second Line Business Practice Location Address:
UNIT 8
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-723-9400
Provider Business Practice Location Address Fax Number:
956-723-9410
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARDUCCI
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
703-437-8330

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0437DC . This is a "BS OF TX" identifier . This identifiers is of the category "OTHER".




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