1285930388 NPI number — WEBB COUNTY IMAGING, LLC

Table of content: (NPI 1285930388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285930388 NPI number — WEBB COUNTY IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEBB COUNTY 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:
LAREDO URGENT CARE
Provider Other Organization Name Type Code:
4
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:
1285930388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9802 MCPHERSON RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78045-6413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-726-0501
Provider Business Mailing Address Fax Number:
956-726-6361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9802 MCPHERSON RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78045-6413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-726-0501
Provider Business Practice Location Address Fax Number:
956-726-6361
Provider Enumeration Date:
02/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LIGHTNER
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
956-726-0501

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  R32972 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2471M1202X , with the licence number: R32972R , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0780DC . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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