Provider Demographics
NPI:1487104246
Name:UPRIGHT MRI OF CLEARLAKE
Entity type:Organization
Organization Name:UPRIGHT MRI OF CLEARLAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-854-4400
Mailing Address - Street 1:3502 SPID DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2909
Mailing Address - Country:US
Mailing Address - Phone:361-854-4400
Mailing Address - Fax:361-854-4420
Practice Address - Street 1:1202 NASA PKWY
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:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty