# GALAXY MRI AND DIAGNOSTIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528121340
- **Authorized official:** DR. JOHN TEIG PORT M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (972) 331-4481

## Contact information

- **Practice address:** 1110 N GALLOWAY AVE, MESQUITE, TX 75149-2436
- **Practice address phone:** (972) 331-4481
- **Practice address fax:** (972) 331-4486
- **Mailing address:** 1110 N GALLOWAY AVE, MESQUITE, TX 75149-2436
- **Mailing address phone:** (972) 331-4481
- **Mailing address fax:** (972) 331-4486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246XS1301X | Sonography Specialist/Technologist Cardiovascular | — | — | — |
| 2471C3401X | Computed Tomography Radiologic Technologist | R29608 | TX | — |
| 2471C3402X | Radiography Radiologic Technologist | R29608 | TX | — |
| 2471M1202X | Magnetic Resonance Imaging Radiologic Technologist | — | TX | — |
| 2471S1302X | Sonography Radiologic Technologist | — | — | — |
| 2471V0105X | Vascular Sonography Radiologic Technologist | — | — | — |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | — | — |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |
| 291U00000X | Clinical Medical Laboratory | 45D1103817 | TX | — |
| 293D00000X | Physiological Laboratory | — | — | — |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 06/15/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 179171701 | — | TX |
| 01 | — | 45D1103817 | CLIA | TX |