Provider Demographics
NPI:1962741959
Name:MRI NOW
Entity type:Organization
Organization Name:MRI NOW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-632-7562
Mailing Address - Street 1:30 CASCADE CAVERNS ROAD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-8308
Mailing Address - Country:US
Mailing Address - Phone:210-609-3349
Mailing Address - Fax:830-331-1042
Practice Address - Street 1:30 CASCADE CAVERNS ROAD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-8308
Practice Address - Country:US
Practice Address - Phone:210-609-3349
Practice Address - Fax:830-331-1042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURENCE R BOWER III MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365018601Medicaid
TX0847DCOtherBCBS