Provider Demographics
NPI:1730212473
Name:BASTROP OPEN MRI L L P PARTNERSHIP
Entity type:Organization
Organization Name:BASTROP OPEN MRI L L P PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-332-0222
Mailing Address - Street 1:3101 HIGHWAY 71 E
Mailing Address - Street 2:SUITE #108
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-5156
Mailing Address - Country:US
Mailing Address - Phone:512-332-0222
Mailing Address - Fax:512-332-0229
Practice Address - Street 1:3101 HIGHWAY 71 E
Practice Address - Street 2:SUITE #108
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5156
Practice Address - Country:US
Practice Address - Phone:512-332-0222
Practice Address - Fax:512-332-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR27271261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155733201Medicaid
TX155733201Medicaid