Provider Demographics
NPI:1154341428
Name:UPRIGHT MRI OF CLEARLAKE LLC
Entity type:Organization
Organization Name:UPRIGHT MRI OF CLEARLAKE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-806-5710
Mailing Address - Street 1:3502 SPID
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415
Mailing Address - Country:US
Mailing Address - Phone:361-854-4400
Mailing Address - Fax:361-854-4420
Practice Address - Street 1:1202 NASA PARKWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3304
Practice Address - Country:US
Practice Address - Phone:281-335-0505
Practice Address - Fax:281-335-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172110201Medicaid
TX172110201Medicaid