Provider Demographics
NPI:1174612444
Name:LAREDO OMI, INC
Entity type:Organization
Organization Name:LAREDO OMI, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-728-1177
Mailing Address - Street 1:209 W VILLAGE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2227
Mailing Address - Country:US
Mailing Address - Phone:956-728-1177
Mailing Address - Fax:
Practice Address - Street 1:209 W VILLAGE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2227
Practice Address - Country:US
Practice Address - Phone:956-728-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742836600OtherTX ID
TX723408OtherMEDICARE
TX742836600OtherTX ID
TX723408OtherMEDICARE