Provider Demographics
NPI:1245428465
Name:MCALLEN MRI, LLC
Entity type:Organization
Organization Name:MCALLEN MRI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO,COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DE LA GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-687-9636
Mailing Address - Street 1:320 N MCCOLL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9358
Mailing Address - Country:US
Mailing Address - Phone:956-687-9636
Mailing Address - Fax:956-687-9743
Practice Address - Street 1:320 N. MCCOLL RD
Practice Address - Street 2:SUITE E
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9358
Practice Address - Country:US
Practice Address - Phone:956-630-0078
Practice Address - Fax:713-583-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088042901Medicaid
TXFTXU63Medicare PIN