Organization
EAST TEXAS OPEN MRI & DIAGNOSTICS L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MISTIE R LACOUNT (ADMIN)
(936) 699-2798
Entity
Organization
Contact information
Practice address
232 NORTH JOHN REDDITT DRIVE, LUFKIN, TX 75904
(936) 699-2798
(936) 699-2885
Mailing address
232 NORTH JOHN REDDITT DRIVE, LUFKIN, TX 75904
(936) 699-2798
(936) 699-2885
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R27244
TX
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152600601
—
TX
01
—
FTX304
MEDICARE PTAN
TX
Enumeration date
03/29/2006
Last updated
09/18/2012
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