1407811177 NPI number — BRIAN RISINGER

Table of content: (NPI 1407811177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407811177 NPI number — BRIAN RISINGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN RISINGER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HILL COUNTY X-RAY PHYSICIANS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407811177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75374-0968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-945-2455
Provider Business Mailing Address Fax Number:
903-453-2541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 EAST FRANKLIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-548-5308
Provider Business Practice Location Address Fax Number:
972-548-5433
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RISINGER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-453-2400

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 095031302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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