1609834969 NPI number — TEXAS IMAGING SERVICES OF EL PASO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609834969 NPI number — TEXAS IMAGING SERVICES OF EL PASO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS IMAGING SERVICES OF EL PASO
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:
OPEN MRI OF EL PASO
Provider Other Organization Name Type Code:
3
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:
1609834969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3480 PRESTON RIDGE RD STE 600
Provider Second Line Business Mailing Address:
CREDENTIALING DEPT
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-300-0101
Provider Business Mailing Address Fax Number:
770-300-0429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10501 GATEWAY BLVD W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925-7934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-591-9000
Provider Business Practice Location Address Fax Number:
915-591-9014
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
770-300-0101

Provider Taxonomy Codes

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

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

  • Identifier: 141647101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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