1275687428 NPI number — WELLSCAN IMAGING LLC

Table of content: (NPI 1275687428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275687428 NPI number — WELLSCAN IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSCAN IMAGING LLC
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:
Provider Other Organization Name Type Code:
6
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:
1275687428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5030 NORTH 10TH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-668-0702
Provider Business Mailing Address Fax Number:
956-682-6108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5030 NORTH 10TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-668-0702
Provider Business Practice Location Address Fax Number:
956-682-6108
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VALENCIA
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-668-0702

Provider Taxonomy Codes

  • Taxonomy code: 2471C3401X , with the licence number:  R26024 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143335101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00320397 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 218DC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".